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Sample records for automated clinical decision

  1. Clinical Decision Support for the Classification of Diabetic Retinopathy: A Comparison of Manual and Automated Results.

    Science.gov (United States)

    Mitsch, Christoph; Fehre, Karsten; Prager, Sonja; Scholda, Christoph; Kriechbaum, Katharina; Wrba, Thomas; Schmidt-Erfurth, Ursula

    2016-01-01

    The management of diabetic retinopathy, a frequent ophthalmological manifestation of diabetes mellitus, consists of regular examinations and a standardized, manual classification of disease severity, which is used to recommend re-examination intervals. To evaluate the feasibility and safety of implementing automated, guideline-based diabetic retinopathy (DR) grading into clinical routine by applying established clinical decision support (CDS) technology. We compared manual with automated classification that was generated using medical documentation and an Arden server with a specific medical logic module. Of 7169 included eyes, 47% (n=3373) showed inter-method classification agreement, specifically 29.4% in mild DR, 38.3% in moderate DR, 27.6% in severe DR, and 65.7% in proliferative DR. We demonstrate that the implementation of a CDS system for automated disease severity classification in diabetic retinopathy is feasible but also that, due to the highly individual nature of medical documentation, certain important criteria for the used electronic health record system need to be met in order to achieve reliable results. PMID:27139380

  2. Designing an automated clinical decision support system to match clinical practice guidelines for opioid therapy for chronic pain

    Directory of Open Access Journals (Sweden)

    Clark Michael E

    2010-04-01

    Full Text Available Abstract Background Opioid prescribing for chronic pain is common and controversial, but recommended clinical practices are followed inconsistently in many clinical settings. Strategies for increasing adherence to clinical practice guideline recommendations are needed to increase effectiveness and reduce negative consequences of opioid prescribing in chronic pain patients. Methods Here we describe the process and outcomes of a project to operationalize the 2003 VA/DOD Clinical Practice Guideline for Opioid Therapy for Chronic Non-Cancer Pain into a computerized decision support system (DSS to encourage good opioid prescribing practices during primary care visits. We based the DSS on the existing ATHENA-DSS. We used an iterative process of design, testing, and revision of the DSS by a diverse team including guideline authors, medical informatics experts, clinical content experts, and end-users to convert the written clinical practice guideline into a computable algorithm to generate patient-specific recommendations for care based upon existing information in the electronic medical record (EMR, and a set of clinical tools. Results The iterative revision process identified numerous and varied problems with the initially designed system despite diverse expert participation in the design process. The process of operationalizing the guideline identified areas in which the guideline was vague, left decisions to clinical judgment, or required clarification of detail to insure safe clinical implementation. The revisions led to workable solutions to problems, defined the limits of the DSS and its utility in clinical practice, improved integration into clinical workflow, and improved the clarity and accuracy of system recommendations and tools. Conclusions Use of this iterative process led to development of a multifunctional DSS that met the approval of the clinical practice guideline authors, content experts, and clinicians involved in testing. The

  3. Use of conditional rule structure to automate clinical decision support: a comparison of artificial intelligence and deterministic programming techniques.

    Science.gov (United States)

    Friedman, R H; Frank, A D

    1983-08-01

    A rule-based computer system was developed to perform clinical decision-making support within a medical information system, oncology practice, and clinical research. This rule-based system, which has been programmed using deterministic rules, possesses features of generalizability, modularity of structure, convenience in rule acquisition, explanability, and utility for patient care and teaching, features which have been identified as advantages of artificial intelligence (AI) rule-based systems. Formal rules are primarily represented as conditional statements; common conditions and actions are stored in system dictionaries so that they can be recalled at any time to form new decision rules. Important similarities and differences exist in the structure of this system and clinical computer systems utilizing artificial intelligence (AI) production rule techniques. The non-AI rule-based system possesses advantages in cost and ease of implementation. The degree to which significant medical decision problems can be solved by this technique remains uncertain as does whether the more complex AI methodologies will be required. PMID:6352165

  4. Clinical decision modeling system

    Directory of Open Access Journals (Sweden)

    Lyons-Weiler James

    2007-08-01

    Full Text Available Abstract Background Decision analysis techniques can be applied in complex situations involving uncertainty and the consideration of multiple objectives. Classical decision modeling techniques require elicitation of too many parameter estimates and their conditional (joint probabilities, and have not therefore been applied to the problem of identifying high-performance, cost-effective combinations of clinical options for diagnosis or treatments where many of the objectives are unknown or even unspecified. Methods We designed a Java-based software resource, the Clinical Decision Modeling System (CDMS, to implement Naïve Decision Modeling, and provide a use case based on published performance evaluation measures of various strategies for breast and lung cancer detection. Because cost estimates for many of the newer methods are not yet available, we assume equal cost. Our use case reveals numerous potentially high-performance combinations of clinical options for the detection of breast and lung cancer. Results Naïve Decision Modeling is a highly practical applied strategy which guides investigators through the process of establishing evidence-based integrative translational clinical research priorities. CDMS is not designed for clinical decision support. Inputs include performance evaluation measures and costs of various clinical options. The software finds trees with expected emergent performance characteristics and average cost per patient that meet stated filtering criteria. Key to the utility of the software is sophisticated graphical elements, including a tree browser, a receiver-operator characteristic surface plot, and a histogram of expected average cost per patient. The analysis pinpoints the potentially most relevant pairs of clinical options ('critical pairs' for which empirical estimates of conditional dependence may be critical. The assumption of independence can be tested with retrospective studies prior to the initiation of

  5. Decision time for clinical decision support systems

    OpenAIRE

    O'Sullivan, D.; Fraccaro, P.; Carson, E; Weller, P

    2014-01-01

    Clinical decision support systems are interactive software systems designed to assist clinicians with decision making tasks, such as determining a diagnosis or recommending a treatment for a patient. Clinical decision support systems are a widely researched topic in the Computer Science community but their inner workings are less well understood by and known to clinicians. In this article we provide a brief explanation of clinical decision support systems and provide some examples of real wor...

  6. Shared clinical decision making

    Science.gov (United States)

    AlHaqwi, Ali I.; AlDrees, Turki M.; AlRumayyan, Ahmad; AlFarhan, Ali I.; Alotaibi, Sultan S.; AlKhashan, Hesham I.; Badri, Motasim

    2015-01-01

    Objectives: To determine preferences of patients regarding their involvement in the clinical decision making process and the related factors in Saudi Arabia. Methods: This cross-sectional study was conducted in a major family practice center in King Abdulaziz Medical City, Riyadh, Saudi Arabia, between March and May 2012. Multivariate multinomial regression models were fitted to identify factors associated with patients preferences. Results: The study included 236 participants. The most preferred decision-making style was shared decision-making (57%), followed by paternalistic (28%), and informed consumerism (14%). The preference for shared clinical decision making was significantly higher among male patients and those with higher level of education, whereas paternalism was significantly higher among older patients and those with chronic health conditions, and consumerism was significantly higher in younger age groups. In multivariate multinomial regression analysis, compared with the shared group, the consumerism group were more likely to be female [adjusted odds ratio (AOR) =2.87, 95% confidence interval [CI] 1.31-6.27, p=0.008] and non-dyslipidemic (AOR=2.90, 95% CI: 1.03-8.09, p=0.04), and the paternalism group were more likely to be older (AOR=1.03, 95% CI: 1.01-1.05, p=0.04), and female (AOR=2.47, 95% CI: 1.32-4.06, p=0.008). Conclusion: Preferences of patients for involvement in the clinical decision-making varied considerably. In our setting, underlying factors that influence these preferences identified in this study should be considered and tailored individually to achieve optimal treatment outcomes. PMID:26620990

  7. Knowledge Automation How to Implement Decision Management in Business Processes

    CERN Document Server

    Fish, Alan N

    2012-01-01

    A proven decision management methodology for increased profits and lowered risks Knowledge Automation: How to Implement Decision Management in Business Processes describes a simple but comprehensive methodology for decision management projects, which use business rules and predictive analytics to optimize and automate small, high-volume business decisions. It includes Decision Requirements Analysis (DRA), a new method for taking the crucial first step in any IT project to implement decision management: defining a set of business decisions and identifying all the information-business knowledge

  8. The decision exploration lab: supporting the business analyst in understanding automated decisions

    OpenAIRE

    Broeksema, Bertjan

    2014-01-01

    A Decision Management System (DMS) provides means to model and automate enterprise decisions and they are applied in a wide range of industries, among which health care, commerce, insurance, finance and transportation. These systems make millions of decisions each day without direct human supervision, impacting the life of millions of people and impacting economies at a large scale. The multiplicative effect of decision automation provides the opportunity to fine-tune the decision system. By ...

  9. How clinical decisions are made

    OpenAIRE

    Bate, Louise; Hutchinson, Andrew; Underhill, Jonathan; Maskrey, Neal

    2012-01-01

    There is much variation in the implementation of the best available evidence into clinical practice. These gaps between evidence and practice are often a result of multiple individual decisions. When making a decision, there is so much potentially relevant information available, it is impossible to know or process it all (so called ‘bounded rationality’). Usually, a limited amount of information is selected to reach a sufficiently satisfactory decision, a process known as satisficing. There a...

  10. Clinical Decision Support (CDS) Inventory

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Clinical Decision Support (CDS) Inventory contains descriptions of past and present CDS projects across the Federal Government. It includes Federal projects,...

  11. COMMON PROBLEMS OF DECISION SUPPORT SYSTEMS IN INDUSTRIAL AUTOMATION

    OpenAIRE

    Бідна Лідія Андріївна

    2015-01-01

    At this stage of governance, many managers are turning to automatic and automated control systems.  Such systems provide a more efficient and systematic approach to solving complex, systemic issues. Now actively use automated systems management in IT companies, as these companies combine a lot of automated processes with important management decisions. If we consider avtamatychne management technique, it is a set of actions aimed at maintaining or improving the functioning of the faci...

  12. Integrating clinical research into clinical decision making

    Directory of Open Access Journals (Sweden)

    Mark R Tonelli

    2011-01-01

    Full Text Available Evidence-based medicine has placed a general priority on knowledge gained from clinical research for clinical decision making. However, knowledge derived from empiric, population-based research, while valued for its ability to limit bias, is not directly applicable to the care of individual patients. The gap between clinical research and individual patient care centers on the fact that empiric research is not generally designed to answer questions of direct relevance to individual patients. Clinicians must utilize other forms of medical knowledge, including pathophysiologic rationale and clinical experience, in order to arrive at the best medical decision for a particular patient. In addition, clinicians must also elucidate and account for the goals and values of individual patients as well as barriers and facilitators of care inherent in the system in which they practice. Evidence-based guidelines and protocols, then, can never be prescriptive. Clinicians must continue to rely on clinical judgment, negotiating potentially conflicting warrants for action, in an effort to arrive at the best decision for a particular patient.

  13. Automated mechanical ventilation: adapting decision making to different disease states.

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    Lozano-Zahonero, S; Gottlieb, D; Haberthür, C; Guttmann, J; Möller, K

    2011-03-01

    The purpose of the present study is to introduce a novel methodology for adapting and upgrading decision-making strategies concerning mechanical ventilation with respect to different disease states into our fuzzy-based expert system, AUTOPILOT-BT. The special features are: (1) Extraction of clinical knowledge in analogy to the daily routine. (2) An automated process to obtain the required information and to create fuzzy sets. (3) The controller employs the derived fuzzy rules to achieve the desired ventilation status. For demonstration this study focuses exclusively on the control of arterial CO(2) partial pressure (p(a)CO(2)). Clinical knowledge from 61 anesthesiologists was acquired using a questionnaire from which different disease-specific fuzzy sets were generated to control p(a)CO(2). For both, patients with healthy lung and with acute respiratory distress syndrome (ARDS) the fuzzy sets show different shapes. The fuzzy set "normal", i.e., "target p(a)CO(2) area", ranges from 35 to 39 mmHg for healthy lungs and from 39 to 43 mmHg for ARDS lungs. With the new fuzzy sets our AUTOPILOT-BT reaches the target p(a)CO(2) within maximal three consecutive changes of ventilator settings. Thus, clinical knowledge can be extended, updated, and the resulting mechanical ventilation therapies can be individually adapted, analyzed, and evaluated. PMID:21069471

  14. Fuzzy Logic in Clinical Practice Decision Support Systems

    OpenAIRE

    Warren, Jim; Beliakov, Gleb; Zwaag, van der, B.J.

    2000-01-01

    Computerized clinical guidelines can provide significant benefits to health outcomes and costs, however, their effective implementation presents significant problems. Vagueness and ambiguity inherent in natural (textual) clinical guidelines is not readily amenable to formulating automated alerts or advice. Fuzzy logic allows us to formalize the treatment of vagueness in a decision support architecture. This paper discusses sources of fuzziness in clinical practice guidelines. We consider how ...

  15. Treatment process - Clinical decision making

    International Nuclear Information System (INIS)

    Full text: Although many aspects of cancer treatment, especially the technical aspects of radiotherapy, are subject to rigorous quality assurance, the quality of actual clinical decision making is rarely scrutinized. There are several developments over the past 10 to 15 years that have driven forward attempts in the UK National Health Service (NHS) to bring such quality assurance into the clinic. This goes back to the work of Dr. Archie Cochrane in the 1970s and his views that clinical practice should be underpinned by research evidence and only treatments that have been shown to be effective should be used. The term clinical effectiveness is now widely used. It refers to the amount by which any treatment actually affects outcomes for patients. For cancer patients this may mean 'cure', improving survival, local control, or symptoms, or minimizing toxicity - or indeed a combination of all of them. But how do we know what is the most effective treatment for a particular patient? How do we assure the quality of the clinical decision? By going to the research evidence and asking questions about whether there is clear evidence which treatment is likely to give the best outcome for this patient. This is 'evidence-based medicine': the application of the best available evidence from clinical care research to the management of individual patients. However this is not just a blind application of this evidence and is not 'cookbook medicine'. Other things need to be considered as well as the evidence, a clinical judgement about the applicability of any treatment to an individual patient and patient preference. When confronted by a patient with a clinical problem, how do we find the 'best' evidence? 1. Refine the clinical question into a standard format: patient, intervention, comparison, and outcomes (PICO) 2. Search for relevant publications in electronic databases, such as Pubmed and Medline, and retrieve them 3. Critically read and appraise them: Are they relevant to this

  16. Automated Preference Elicitation for Decision Making

    Czech Academy of Sciences Publication Activity Database

    Kárný, Miroslav

    Vol. 3. Berlin: Springer, 2013, s. 65-99. (Studies in Computational Intelligence. 474). ISBN 978-3-642-36405-1 R&D Projects: GA ČR GA13-13502S; GA ČR GA102/08/0567 Institutional research plan: CEZ:AV0Z1075907 Institutional support: RVO:67985556 Keywords : Bayesian decision making * fully probabilistic design * DM preference elicitation * support of imperfect participants Subject RIV: BC - Control Systems Theory http://library.utia.cas.cz/separaty/2013/AS/karny-0389631.pdf

  17. Automated radiochemical processing for clinical PET

    International Nuclear Information System (INIS)

    The Siemens RDS 112, an automated radiochemical production and delivery system designed to support a clinical PET program, consists of an 11 MeV, proton only, negative ion cyclotron, a shield, a computer, and targetry and chemical processing modules to produce radiochemicals used in PET imaging. The principal clinical PET tracers are [18F]FDG, [13N]ammonia and [15O]water. Automated synthesis of [18F]FDG is achieved using the Chemistry Process Control Unit (CPCU), a general purpose valve-and-tubing device that emulates manual processes while allowing for competent operator intervention. Using function-based command file software, this pressure-driven synthesis system carries out chemical processing procedures by timing only, without process-based feedback. To date, nine CPCUs have installed at seven institutions resulting in 1,200+ syntheses of [18F]FDG, with an average yield of 55% (EOB)

  18. Economic aspects of clinical decision making: applications of clinical decision analysis.

    Science.gov (United States)

    Crane, V S

    1988-03-01

    Clinical decision analysis as a basic tool for decision making is described, and potential applications of decision analysis in six areas of clinical practice are identified. Clinical decision analysis is a systematic method of describing clinical problems in a quantitative fashion, identifying possible courses of action, assessing the probability and value of outcomes, and then making a calculation to select the ultimate course of action. Clinical decision analysis provides a structure for clinical decision problems, helps clarify medical controversies, and encourages decision makers to speak a common language. Applications of clinical decision analysis in the areas of diagnostic testing, patient management, product and program selection, research and education, patient preferences, and health-care-policy evaluation are described. Decision analysis offers health professionals a tool for making quantifiable, cost-effective clinical decisions, especially in terms of clinical outcomes. PMID:3285672

  19. Decision-fusion-based automated drill bit toolmark correlator

    Science.gov (United States)

    Jones, Brett C.; Press, Michael J.; Guerci, Joseph R.

    1999-02-01

    This paper describes a recent study conducted to investigate the reproducibility of toolmarks left by drill bits. This paper focuses on the automated analysis aspect of the study, and particularly the advantages of using decision fusion methods in the comparisons. To enable the study to encompass a large number of samples, existing technology was adapted to the task of automatically comparing the test impressions. Advanced forensic pattern recognition algorithms that had been developed for the comparison of ballistic evidence in the DRUGFIRETM system were modified for use in this test. The results of the decision fusion architecture closely matched those obtained by expert visual examination. The study, aided by the improved pattern recognition algorithm, showed that drill bit impressions do contain reproducible marks. In a blind test, the DRUGFIRE pattern recognition algorithm, enhanced with the decision fusion architecture, consistently identified the correct bit as the source of the test impressions.

  20. An automated approach to the design of decision tree classifiers

    Science.gov (United States)

    Argentiero, P.; Chin, P.; Beaudet, P.

    1980-01-01

    The classification of large dimensional data sets arising from the merging of remote sensing data with more traditional forms of ancillary data is considered. Decision tree classification, a popular approach to the problem, is characterized by the property that samples are subjected to a sequence of decision rules before they are assigned to a unique class. An automated technique for effective decision tree design which relies only on apriori statistics is presented. This procedure utilizes a set of two dimensional canonical transforms and Bayes table look-up decision rules. An optimal design at each node is derived based on the associated decision table. A procedure for computing the global probability of correct classfication is also provided. An example is given in which class statistics obtained from an actual LANDSAT scene are used as input to the program. The resulting decision tree design has an associated probability of correct classification of .76 compared to the theoretically optimum .79 probability of correct classification associated with a full dimensional Bayes classifier. Recommendations for future research are included.

  1. Legal Considerations in Clinical Decision Making.

    Science.gov (United States)

    Ursu, Samuel C.

    1992-01-01

    Discussion of legal issues in dental clinical decision making looks at the nature and elements of applicable law, especially malpractice, locus of responsibility, and standards of care. Greater use of formal decision analysis in clinical dentistry and better research on diagnosis and treatment are recommended, particularly in light of increasing…

  2. ClinicalAccess: a clinical decision support tool.

    Science.gov (United States)

    Crowell, Karen; Vardell, Emily

    2015-01-01

    ClinicalAccess is a new clinical decision support tool that uses a question-and-answer format to mirror clinical decision-making strategies. The unique format of ClinicalAccess delivers concise, authoritative answers to more than 120,000 clinical questions. This column presents a review of the product, a sample search, and a comparison with other point-of-care search engines. PMID:25927513

  3. Pilot interaction with automated airborne decision making systems

    Science.gov (United States)

    Hammer, John M.

    1990-01-01

    Ways in which computers can aid the decision making of an human operator of an aerospace system are investigated. The approach taken is to aid rather than replace the human operator, because operational experience has shown that humans can enhance the effectiveness of systems. As systems become more automated, the role of the operator has shifted to that of a manager and problem solver. This shift has created the research area of how to aid the human in this role. Published research in four areas is described. A discussion is presented of the DC-8 flight simulator at Georgia Tech.

  4. A Decision Support Framework for Automated Screening of Diabetic Retinopathy

    Directory of Open Access Journals (Sweden)

    H. Thompson

    2006-02-01

    Full Text Available The early signs of diabetic retinopathy (DR are depicted by microaneurysms among other signs. A prompt diagnosis when the disease is at the early stage can help prevent irreversible damages to the diabetic eye. In this paper, we propose a decision support system (DSS for automated screening of early signs of diabetic retinopathy. Classification schemes for deducing the presence or absence of DR are developed and tested. The detection rule is based on binary-hypothesis testing problem which simplifies the problem to yes/no decisions. An analysis of the performance of the Bayes optimality criteria applied to DR is also presented. The proposed DSS is evaluated on the real-world data. The results suggest that by biasing the classifier towards DR detection, it is possible to make the classifier achieve good sensitivity.

  5. Clinical Decision Making of Rural Novice Nurses

    Science.gov (United States)

    Seright, Teresa J.

    2010-01-01

    The purpose of this study was to develop substantive theory regarding decision making by the novice nurse in a rural hospital setting. Interviews were guided by the following research questions: What cues were used by novice rural registered nurses in order to make clinical decisions? What were the sources of feedback which influenced subsequent…

  6. Laboratory automation in clinical bacteriology: what system to choose?

    Science.gov (United States)

    Croxatto, A; Prod'hom, G; Faverjon, F; Rochais, Y; Greub, G

    2016-03-01

    Automation was introduced many years ago in several diagnostic disciplines such as chemistry, haematology and molecular biology. The first laboratory automation system for clinical bacteriology was released in 2006, and it rapidly proved its value by increasing productivity, allowing a continuous increase in sample volumes despite limited budgets and personnel shortages. Today, two major manufacturers, BD Kiestra and Copan, are commercializing partial or complete laboratory automation systems for bacteriology. The laboratory automation systems are rapidly evolving to provide improved hardware and software solutions to optimize laboratory efficiency. However, the complex parameters of the laboratory and automation systems must be considered to determine the best system for each given laboratory. We address several topics on laboratory automation that may help clinical bacteriologists to understand the particularities and operative modalities of the different systems. We present (a) a comparison of the engineering and technical features of the various elements composing the two different automated systems currently available, (b) the system workflows of partial and complete laboratory automation, which define the basis for laboratory reorganization required to optimize system efficiency, (c) the concept of digital imaging and telebacteriology, (d) the connectivity of laboratory automation to the laboratory information system, (e) the general advantages and disadvantages as well as the expected impacts provided by laboratory automation and (f) the laboratory data required to conduct a workflow assessment to determine the best configuration of an automated system for the laboratory activities and specificities. PMID:26806135

  7. Grand challenges in clinical decision support.

    Science.gov (United States)

    Sittig, Dean F; Wright, Adam; Osheroff, Jerome A; Middleton, Blackford; Teich, Jonathan M; Ash, Joan S; Campbell, Emily; Bates, David W

    2008-04-01

    There is a pressing need for high-quality, effective means of designing, developing, presenting, implementing, evaluating, and maintaining all types of clinical decision support capabilities for clinicians, patients and consumers. Using an iterative, consensus-building process we identified a rank-ordered list of the top 10 grand challenges in clinical decision support. This list was created to educate and inspire researchers, developers, funders, and policy-makers. The list of challenges in order of importance that they be solved if patients and organizations are to begin realizing the fullest benefits possible of these systems consists of: improve the human-computer interface; disseminate best practices in CDS design, development, and implementation; summarize patient-level information; prioritize and filter recommendations to the user; create an architecture for sharing executable CDS modules and services; combine recommendations for patients with co-morbidities; prioritize CDS content development and implementation; create internet-accessible clinical decision support repositories; use freetext information to drive clinical decision support; mine large clinical databases to create new CDS. Identification of solutions to these challenges is critical if clinical decision support is to achieve its potential and improve the quality, safety and efficiency of healthcare. PMID:18029232

  8. Clinical Productivity System - A Decision Support Model

    CERN Document Server

    Bennett, Casey C

    2012-01-01

    Purpose: This goal of this study was to evaluate the effects of a data-driven clinical productivity system that leverages Electronic Health Record (EHR) data to provide productivity decision support functionality in a real-world clinical setting. The system was implemented for a large behavioral health care provider seeing over 75,000 distinct clients a year. Design/methodology/approach: The key metric in this system is a "VPU", which simultaneously optimizes multiple aspects of clinical care. The resulting mathematical value of clinical productivity was hypothesized to tightly link the organization's performance to its expectations and, through transparency and decision support tools at the clinician level, affect significant changes in productivity, quality, and consistency relative to traditional models of clinical productivity. Findings: In only 3 months, every single variable integrated into the VPU system showed significant improvement, including a 30% rise in revenue, 10% rise in clinical percentage, a...

  9. A health examination system integrated with clinical decision support system.

    Science.gov (United States)

    Kuo, Kuan-Liang; Fuh, Chiou-Shann

    2010-10-01

    Health examinations play a key role in preventive medicine. We propose a health examination system named Health Examination Automatic Logic System (HEALS) to assist clinical workers in improving the total quality of health examinations. Quality of automated inference is confirmed by the zero inference error where during 6 months and 14,773 cases. Automated inference time is less than one second per case in contrast to 2 to 5 min for physicians. The most significant result of efficiency evaluation is that 3,494 of 4,356 (80.2%) cases take less than 3 min per case for producing a report summary. In the evaluation of effectiveness, novice physicians got 18% improvement in making decisions with the assistance of our system. We conclude that a health examination system with a clinical decision system can greatly reduce the mundane burden on clinical workers and markedly improve the quality and efficiency of health examination tasks. PMID:20703626

  10. Clinical decision making in veterinary practice

    OpenAIRE

    Everitt, Sally

    2011-01-01

    Aim The aim of this study is to develop an understanding of the factors which influence veterinary surgeons’ clinical decision making during routine consultations. Methods The research takes a qualitative approach using video-cued interviews, in which one of the veterinary surgeon’s own consultations is used as the basis of a semi-structured interview exploring decision making in real cases. The research focuses primarily on small animal consultations in first opinion practice, how...

  11. Information theory models for clinical decision support

    Czech Academy of Sciences Publication Activity Database

    Vajda, Igor

    Praha : Ústav informatiky AV ČR, v.v.i, 2009 - (Z. Valenta). s. 117-117 [Výroční konference Mezinárodní společnosti pro klinickou biostatistiku /30./. 23.08.2009-27.08.2009, Praha] R&D Projects: GA MŠk 1M06014; GA MŠk(CZ) 1M0572 Institutional research plan: CEZ:AV0Z10750506 Keywords : Information * decision error * decision risk * ROC curve * information bounds Subject RIV: BD - Theory of Information http://library.utia.cas.cz/separaty/2010/SI/vajda-information theory models for clinical decision support.doc

  12. Clinical decision support system in dental implantology

    OpenAIRE

    Alexandra Polášková; Jitka Feberová; Taťjána Dostálová; Pavel Kříž; Michaela Seydlová

    2013-01-01

    Implantology is rapidly developing interdisciplinary field providing enormous amounts of data to be classified, evaluated and interpreted. The analysis of clinical data remains a big challenge, because each new system has specific requirements. The aim of study was prepare specific tool for treatment planning. Decision support system is built on Expert system. It is interactive software which provides clinical recommendations and treatment planning. Expert systems are knowledge-based computer...

  13. Entrustment Decision Making in Clinical Training.

    Science.gov (United States)

    Ten Cate, Olle; Hart, Danielle; Ankel, Felix; Busari, Jamiu; Englander, Robert; Glasgow, Nicholas; Holmboe, Eric; Iobst, William; Lovell, Elise; Snell, Linda S; Touchie, Claire; Van Melle, Elaine; Wycliffe-Jones, Keith

    2016-02-01

    The decision to trust a medical trainee with the critical responsibility to care for a patient is fundamental to clinical training. When carefully and deliberately made, such decisions can serve as significant stimuli for learning and also shape the assessment of trainees. Holding back entrustment decisions too much may hamper the trainee's development toward unsupervised practice. When carelessly made, however, they jeopardize patient safety. Entrustment decision-making processes, therefore, deserve careful analysis.Members (including the authors) of the International Competency-Based Medical Education Collaborative conducted a content analysis of the entrustment decision-making process in health care training during a two-day summit in September 2013 and subsequently reviewed the pertinent literature to arrive at a description of the critical features of this process, which informs this article.The authors discuss theoretical backgrounds and terminology of trust and entrustment in the clinical workplace. The competency-based movement and the introduction of entrustable professional activities force educators to rethink the grounds for assessment in the workplace. Anticipating a decision to grant autonomy at a designated level of supervision appears to align better with health care practice than do most current assessment practices. The authors distinguish different modes of trust and entrustment decisions and elaborate five categories, each with related factors, that determine when decisions to trust trainees are made: the trainee, supervisor, situation, task, and the relationship between trainee and supervisor. The authors' aim in this article is to lay a theoretical foundation for a new approach to workplace training and assessment. PMID:26630606

  14. Clinical Decision Support Systems: A Useful Tool in Clinical Practice

    Directory of Open Access Journals (Sweden)

    Kolostoumpis G.

    2012-01-01

    Full Text Available The possibility of supporting in decision – making shows an increase in recent years. Based on mathematic simulation tools, knowledge databases, processing methods, medical data and methods, artificial intelligence for coding of the available knowledge and for resolving complex problems arising into clinical practice. Aim: the aim of this review is to present the development of new methods and modern services, in clinical practice and the emergence in their implementation. Data and methods: the methodology that was followed included research of articles that referred to health sector and modern technologies, at the electronic data bases “pubmed” and “medline”. Results: Is a useful tool for medical experts using characteristics and medical data used by the doctors. Constitute innovation for the medical community, and ensure the support of clinical decisions with an overall way by providing a comprehensive solution in the light of the integration of computational decision support systems into clinical practice. Conclusions: Decision Support Systems contribute to improving the quality of health services with simultaneous impoundment of costs (i.e. avoid medical errors

  15. Nurses' Clinical Decision Making on Adopting a Wound Clinical Decision Support System.

    Science.gov (United States)

    Khong, Peck Chui Betty; Hoi, Shu Yin; Holroyd, Eleanor; Wang, Wenru

    2015-07-01

    Healthcare information technology systems are considered the ideal tool to inculcate evidence-based nursing practices. The wound clinical decision support system was built locally to support nurses to manage pressure ulcer wounds in their daily practice. However, its adoption rate is not optimal. The study's objective was to discover the concepts that informed the RNs' decisions to adopt the wound clinical decision support system as an evidence-based technology in their nursing practice. This was an exploratory, descriptive, and qualitative design using face-to-face interviews, individual interviews, and active participatory observation. A purposive, theoretical sample of 14 RNs was recruited from one of the largest public tertiary hospitals in Singapore after obtaining ethics approval. After consenting, the nurses were interviewed and observed separately. Recruitment stopped when data saturation was reached. All transcribed interview data underwent a concurrent thematic analysis, whereas observational data were content analyzed independently and subsequently triangulated with the interview data. Eight emerging themes were identified, namely, use of the wound clinical decision support system, beliefs in the wound clinical decision support system, influences of the workplace culture, extent of the benefits, professional control over nursing practices, use of knowledge, gut feelings, and emotions (fear, doubt, and frustration). These themes represented the nurses' mental outlook as they made decisions on adopting the wound clinical decision support system in light of the complexities of their roles and workloads. This research has provided insight on the nurses' thoughts regarding their decision to interact with the computer environment in a Singapore context. It captured the nurses' complex thoughts when deciding whether to adopt or reject information technology as they practice in a clinical setting. PMID:26066306

  16. Fuzzy Logic in Clinical Practice Decision Support Systems

    NARCIS (Netherlands)

    Warren, Jim; Beliakov, Gleb; Zwaag, van der Berend

    2000-01-01

    Computerized clinical guidelines can provide significant benefits to health outcomes and costs, however, their effective implementation presents significant problems. Vagueness and ambiguity inherent in natural (textual) clinical guidelines is not readily amenable to formulating automated alerts or

  17. [Clinical decisions in a philosophical perspective].

    Science.gov (United States)

    Wulff, H R

    1993-09-20

    Medicine is both a scientific and a humanistic discipline. The foundation for clinical decisions has four components (two scientific and two humanistic). 1) The biological component (reasoning based on biological theory). Biological thinking is currently being revolutionised, partly through the development of systems theory. 2) The empirical component (reasoning based on experience from earlier patients), which comprises both uncontrolled and controlled experience. 3) The empathic-hermeneutic component (reasoning based on an understanding of the patient as a fellow human being). Empathy requires hermeneutic knowledge which can be acquired through personal experience and by qualitative research. 4) The ethical component which comprises both utilitarian and deontological considerations. PMID:8211903

  18. Clinical decision-making: physicians' preferences and experiences

    OpenAIRE

    White Martha; Pollack Lance; Murray Elizabeth; Lo Bernard

    2007-01-01

    Abstract Background Shared decision-making has been advocated; however there are relatively few studies on physician preferences for, and experiences of, different styles of clinical decision-making as most research has focused on patient preferences and experiences. The objectives of this study were to determine 1) physician preferences for different styles of clinical decision-making; 2) styles of clinical decision-making physicians perceive themselves as practicing; and 3) the congruence b...

  19. An integrated and interactive decision support system for automated melanoma recognition of dermoscopic images.

    Science.gov (United States)

    Rahman, M M; Bhattacharya, P

    2010-09-01

    This paper presents an integrated and interactive decision support system for the automated melanoma recognition of the dermoscopic images based on image retrieval by content and multiple expert fusion. In this context, the ultimate aim is to support the decision making by retrieving and displaying the relevant past cases as well as predicting the image categories (e.g., melanoma, benign and dysplastic nevi) by combining outputs from different classifiers. However, the most challenging aspect in this domain is to detect the lesion from the healthy background skin and extract the lesion-specific local image features. A thresholding-based segmentation method is applied on the intensity images generated from two different schemes to detect the lesion. For the fusion-based image retrieval and classification, the lesion-specific local color and texture features are extracted and represented in the form of the mean and variance-covariance of color channels and in a combined feature space. The performance is evaluated by using both the precision-recall and classification accuracies. Experimental results on a dermoscopic image collection demonstrate the effectiveness of the proposed system and show the viability of a real-time clinical application. PMID:19942406

  20. Defining the drivers for accepting decision making automation in air traffic management.

    Science.gov (United States)

    Bekier, Marek; Molesworth, Brett R C; Williamson, Ann

    2011-04-01

    Air Traffic Management (ATM) operators are under increasing pressure to improve the efficiency of their operation to cater for forecasted increases in air traffic movements. One solution involves increasing the utilisation of automation within the ATM system. The success of this approach is contingent on Air Traffic Control Operators' (ATCOs) willingness to accept increased levels of automation. The main aim of the present research was to examine the drivers underpinning ATCOs' willingness to accept increased utilisation of automation within their role. Two fictitious scenarios involving the application of two new automated decision-making tools were created. The results of an online survey revealed traditional predictors of automation acceptance such as age, trust and job satisfaction explain between 4 and 7% of the variance. Furthermore, these predictors varied depending on the purpose in which the automation was to be employed. These results are discussed from an applied and theoretical perspective. STATEMENT OF RELEVANCE: Efficiency improvements in ATM are required to cater for forecasted increases in air traffic movements. One solution is to increase the utilisation of automation within Air Traffic Control. The present research examines the drivers underpinning air traffic controllers' willingness to accept increased levels of automation in their role. PMID:21491277

  1. Realizing a decision support system for different deployment automation approaches

    OpenAIRE

    Shao, Bing

    2014-01-01

    In recent years more and more IT enterprises use Cloud computing to deliver their services. To deploy services on the Cloud, there are different Deployment Automation Approaches (DAA) available, e.g. PaaS- and IaaS-based DAA. It's must be ensured, a particular service is deployable using a certain DAA, which means the deployment requirements of the service are fulfilled by the DAA. There are plenty of particular DAAs on the market. Some of them have different but similar features. Therefore a...

  2. An Example for BeSpaceD and its Use for Decision Support in Industrial Automation

    OpenAIRE

    Blech, Jan Olaf

    2015-01-01

    We describe our formal methods-based spatial reasoning framework BeSpaceD and its application in decision support for industrial automation. In particular we are supporting analysis and decisions based on formal models for industrial plant and mining operations. BeSpaceD is a framework for deciding geometric and topological properties of spatio-temporal models. We present an example and report on our ongoing experience with applications in different projects around software and cyber-physical...

  3. Amsterdam wrist rules: A clinical decision aid

    Directory of Open Access Journals (Sweden)

    Bentohami Abdelali

    2011-10-01

    Full Text Available Abstract Background Acute trauma of the wrist is one of the most frequent reasons for visiting the Emergency Department. These patients are routinely referred for radiological examination. Most X-rays however, do not reveal any fractures. A clinical decision rule determining the need for X-rays in patients with acute wrist trauma may help to percolate and select patients with fractures. Methods/Design This study will be a multi-center observational diagnostic study in which the data will be collected cross-sectionally. The study population will consist of all consecutive adult patients (≥18 years presenting with acute wrist trauma at the Emergency Department in the participating hospitals. This research comprises two components: one study will be conducted to determine which clinical parameters are predictive for the presence of a distal radius fracture in adult patients presenting to the Emergency Department following acute wrist trauma. These clinical parameters are defined by trauma-mechanism, physical examination, and functional testing. This data will be collected in two of the three participating hospitals and will be assessed by using logistic regression modelling to estimate the regression coefficients after which a reduced model will be created by means of a log likelihood ratio test. The accuracy of the model will be estimated by a goodness of fit test and an ROC curve. The final model will be validated internally through bootstrapping and by shrinking it, an adjusted model will be generated. In the second component of this study, the developed prediction model will be validated in a new dataset consisting of a population of patients from the third hospital. If necessary, the model will be calibrated using the data from the validation study. Discussion Wrist trauma is frequently encountered at the Emergency Department. However, to this date, no decision rule regarding this type of trauma has been created. Ideally, radiographs are

  4. Cost Recovery in Pricing and Capacity Decisions for Automated Information Systems. Final Report.

    Science.gov (United States)

    Dei Rossi, James A.

    This paper examines the cost-benefit implications of alternative pricing and capacity investment decisions for automated scientific and technical information retrieval systems. Two typical systems are examined and numerical examples presented. In the first system, search requests are entered on-site. The show how setting price to maximize net…

  5. Combining Various Methods of Automated User Decision and Preferences Modelling

    Czech Academy of Sciences Publication Activity Database

    Eckhardt, Alan; Vojtáš, Peter

    Berlin: Springer, 2009 - (Torra, V.; Narukawa, Y.; Inuiguchi, M.), s. 172-181. (Lecture Notes in Artificial Intelligence. 5861). ISBN 978-3-642-04819-7. [MDAI 2009. Internationa Conference on Modeling Decisions for Artificial Intelligence /6./. Awaji Island (JP), 30.11.2009-02.12.2009] R&D Projects: GA AV ČR 1ET100300517 Institutional research plan: CEZ:AV0Z10300504 Keywords : user preferences learning * recommender systems Subject RIV: IN - Informatics, Computer Science

  6. Outpatient diabetes clinical decision support: current status and future directions.

    Science.gov (United States)

    O'Connor, P J; Sperl-Hillen, J M; Fazio, C J; Averbeck, B M; Rank, B H; Margolis, K L

    2016-06-01

    Outpatient clinical decision support systems have had an inconsistent impact on key aspects of diabetes care. A principal barrier to success has been low use rates in many settings. Here, we identify key aspects of clinical decision support system design, content and implementation that are related to sustained high use rates and positive impacts on glucose, blood pressure and lipid management. Current diabetes clinical decision support systems may be improved by prioritizing care recommendations, improving communication of treatment-relevant information to patients, using such systems for care coordination and case management and integrating patient-reported information and data from remote devices into clinical decision algorithms and interfaces. PMID:27194173

  7. Fuzzy-Arden-Syntax-based, Vendor-agnostic, Scalable Clinical Decision Support and Monitoring Platform.

    Science.gov (United States)

    Adlassnig, Klaus-Peter; Fehre, Karsten; Rappelsberger, Andrea

    2015-01-01

    This study's objective is to develop and use a scalable genuine technology platform for clinical decision support based on Arden Syntax, which was extended by fuzzy set theory and fuzzy logic. Arden Syntax is a widely recognized formal language for representing clinical and scientific knowledge in an executable format, and is maintained by Health Level Seven (HL7) International and approved by the American National Standards Institute (ANSI). Fuzzy set theory and logic permit the representation of knowledge and automated reasoning under linguistic and propositional uncertainty. These forms of uncertainty are a common feature of patients' medical data, the body of medical knowledge, and deductive clinical reasoning. PMID:26262410

  8. A service oriented approach for guidelines-based clinical decision support using BPMN.

    Science.gov (United States)

    Rodriguez-Loya, Salvador; Aziz, Ayesha; Chatwin, Chris

    2014-01-01

    Evidence-based medical practice requires that clinical guidelines need to be documented in such a way that they represent a clinical workflow in its most accessible form. In order to optimize clinical processes to improve clinical outcomes, we propose a Service Oriented Architecture (SOA) based approach for implementing clinical guidelines that can be accessed from an Electronic Health Record (EHR) application with a Web Services enabled communication mechanism with the Enterprise Service Bus. We have used Business Process Modelling Notation (BPMN) for modelling and presenting the clinical pathway in the form of a workflow. The aim of this study is to produce spontaneous alerts in the healthcare workflow in the diagnosis of Chronic Obstructive Pulmonary Disease (COPD). The use of BPMN as a tool to automate clinical guidelines has not been previously employed for providing Clinical Decision Support (CDS). PMID:25160142

  9. Modeling Knowledge Bases for Automated Decision Making Systems – A Literature Review

    Directory of Open Access Journals (Sweden)

    Franz Felix Füssl

    2015-09-01

    Full Text Available Developing automated decision making systems means dealing with knowledge in every possible manner. One of the most important points of developing artificial intelligent systems is developing a precise knowledge base with integrating self-learning mechanisms. Moreover using knowledge in expert systems or decision support systems it is necessary to document knowledge and make it visible for managing it. Main goal of this work is finding a suitable solution for modeling knowledge bases in automated decision making systems concerning both illustrating specific knowledge and learning mechanisms. There are a lot of different terms describing this kind of research, such as knowledge modeling, knowledge engineering or ontology engineering. For that reason this paper provides a comparison of the technical terms in this domain by illustrating similarities, specifics and how they are used in literature.

  10. Implications of caries diagnostic strategies for clinical management decisions

    DEFF Research Database (Denmark)

    Baelum, Vibeke; Hintze, Hanne; Wenzel, Ann;

    2012-01-01

    OBJECTIVES: In clinical practice, a visual-tactile caries examination is frequently supplemented by bitewing radiography. This study evaluated strategies for combining visual-tactile and radiographic caries detection methods and determined their implications for clinical management decisions in a...

  11. Automated radiosynthesis of [11C]morphine for clinical investigation

    International Nuclear Information System (INIS)

    To meet a multiple-dose clinical evaluation of the P-gp modulation of [11C]morphine delivery into the human brain, radiosynthesis of [11C]morphine was accomplished on an automated system by N-methylation of normorphine with [11C]CH3I. A methodology employing optimized solid phase extraction of the HPLC eluent was developed. Radiosynthesis took 45 min with a radiochemical yield ranging from 45% to 50% and specific activity ranging from 20 to 26 Ci/μmol (decay corrected to end-of-bombardment); radiochemical and chemical purities were >95% (n=28).

  12. Clinical Decision Making of Nurses Working in Hospital Settings

    OpenAIRE

    Ida Torunn Bjørk; Hamilton, Glenys A.

    2011-01-01

    This study analyzed nurses' perceptions of clinical decision making (CDM) in their clinical practice and compared differences in decision making related to nurse demographic and contextual variables. A cross-sectional survey was carried out with 2095 nurses in four hospitals in Norway. A 24-item Nursing Decision Making Instrument based on cognitive continuum theory was used to explore how nurses perceived their CDM when meeting an elective patient for the first time. Data were analyzed with d...

  13. Automation bias and prescribing decision support – rates, mediators and mitigators

    OpenAIRE

    Goddard, Kate

    2012-01-01

    Purpose: Computerised clinical decision support systems (CDSS) are implemented within healthcare settings as a method to improve clinical decision quality, safety and effectiveness, and ultimately patient outcomes. Though CDSSs tend to improve practitioner performance and clinical outcomes, relatively little is known about specific impact of inaccurate CDSS output on clinicians. Although there is high heterogeneity between CDSS types and studies, reviews of the ability of CDSS to prevent medi...

  14. Theory of Evidence-Based Automated Decision Making in Cyber-Physical Systems

    OpenAIRE

    SIATERLIS CHRISTOS; GENGE BELA

    2011-01-01

    The Smart Grid is a complex cyber-physical system that is evolving rapidly from a relatively isolated to an open and diverse environment. Within this context, enhancing the security of the future Smart Grid becomes a major priority. In this paper we introduce the use of data fusion for automated decision making in cyber-physical systems such as the Smart Grid. One of the most important applications of decision making is in the field of anomaly detection. This can enable the detection of attac...

  15. Development of an Automated Decision-Making Tool for Supervisory Control System

    Energy Technology Data Exchange (ETDEWEB)

    Cetiner, Sacit M. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Muhlheim, Michael David [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Flanagan, George F. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Fugate, David L. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Kisner, Roger A. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2014-09-01

    This technical report was generated as a product of the Supervisory Control for Multi-Modular Small Modular Reactor (SMR) Plants project within the Instrumentation, Control and Human-Machine Interface technology area under the Advanced Small Modular Reactor (AdvSMR) Research and Development Program of the US Department of Energy. The report documents the definition of strategies, functional elements, and the structural architecture of a supervisory control system for multi-modular AdvSMR plants. This research activity advances the state of the art by incorporating real-time, probabilistic-based decision-making into the supervisory control system architectural layers through the introduction of a tiered-plant system approach. The report provides background information on the state of the art of automated decision-making, including the description of existing methodologies. It then presents a description of a generalized decision-making framework, upon which the supervisory control decision-making algorithm is based. The probabilistic portion of automated decision-making is demonstrated through a simple hydraulic loop example.

  16. Agent Technology Application in Automating the Coordination and Decision-Making in Supply Chain

    Institute of Scientific and Technical Information of China (English)

    JIE Hui; JI Jian-hua

    2005-01-01

    Coordinating all the activities among all the parties involved in supply chain can be a daunting task. This paper put forth the viewpoint of applying agent technology to automate the coordination and decision-making tasks in a typical home PC industry supply chain. The main features of the proposed approach, which differentiate it cesses and issues faced by parties in the supply chain. A prototype and the overall process flow were also described.

  17. AIDSS-HR: An Automated Intelligent Decision Support System for Enhancing the Performance of Employees

    OpenAIRE

    Nana Yaw Asabere; Nana Kwame Gyamfi

    2013-01-01

    The performance of employees in an organization is a very important issue for effective delivery and output. Various performance management systems with the aid of Information and Communication Technology (ICT) are currently being used by companies. Such systems are most of the time connected and accessible through to the internet/www. Through review of relevant literature and a system development methodology, this paper proposes an Automated Intelligent Decision Support – Human Resource (AID...

  18. A Synthesis of Decision Models for Tool Management in Automated Manufacturing

    OpenAIRE

    Ann E. Gray; Abraham (Avi) Seidmann; Kathryn E. Stecke

    1993-01-01

    The evidence is clear that a lack of attention to structured tool management has resulted in the poor performance of many manufacturing systems. Plant tooling systems affect product design options, machine loading, job batching, capacity scheduling, and real-time part routing decisions. With increasing automation in manufacturing systems, there is a growing need to integrate tool management more thoroughly into system design, planning and control. This paper critically evaluates various tool ...

  19. Multimedia abstract generation of intensive care data: the automation of clinical processes through AI methodologies.

    Science.gov (United States)

    Jordan, Desmond; Rose, Sydney E

    2010-04-01

    Medical errors from communication failures are enormous during the perioperative period of cardiac surgical patients. As caregivers change shifts or surgical patients change location within the hospital, key information is lost or misconstrued. After a baseline cognitive study of information need and caregiver workflow, we implemented an advanced clinical decision support tool of intelligent agents, medical logic modules, and text generators called the "Inference Engine" to summarize individual patient's raw medical data elements into procedural milestones, illness severity, and care therapies. The system generates two displays: 1) the continuum of care, multimedia abstract generation of intensive care data (MAGIC)-an expert system that would automatically generate a physician briefing of a cardiac patient's operative course in a multimodal format; and 2) the isolated point in time, "Inference Engine"-a system that provides a real-time, high-level, summarized depiction of a patient's clinical status. In our studies, system accuracy and efficacy was judged against clinician performance in the workplace. To test the automated physician briefing, "MAGIC," the patient's intraoperative course, was reviewed in the intensive care unit before patient arrival. It was then judged against the actual physician briefing and that given in a cohort of patients where the system was not used. To test the real-time representation of the patient's clinical status, system inferences were judged against clinician decisions. Changes in workflow and situational awareness were assessed by questionnaires and process evaluation. MAGIC provides 200% more information, twice the accuracy, and enhances situational awareness. This study demonstrates that the automation of clinical processes through AI methodologies yields positive results. PMID:20012610

  20. Clinical Decision Support: Statistical Hopes and Challenges

    Czech Academy of Sciences Publication Activity Database

    Kalina, Jan; Zvárová, Jana

    2016-01-01

    Roč. 4, č. 1 (2016), s. 30-34. ISSN 1805-8698 Grant ostatní: Nadační fond na opdporu vědy(CZ) Neuron Institutional support: RVO:67985807 Keywords : decision support * data mining * multivariate statistics * psychiatry * information based medicine Subject RIV: BB - Applied Statistics, Operational Research

  1. Checking the Quality of Clinical Guidelines using Automated Reasoning Tools

    CERN Document Server

    Hommersom, Arjen; van Bommel, Patrick

    2008-01-01

    Requirements about the quality of clinical guidelines can be represented by schemata borrowed from the theory of abductive diagnosis, using temporal logic to model the time-oriented aspects expressed in a guideline. Previously, we have shown that these requirements can be verified using interactive theorem proving techniques. In this paper, we investigate how this approach can be mapped to the facilities of a resolution-based theorem prover, Otter, and a complementary program that searches for finite models of first-order statements, Mace. It is shown that the reasoning required for checking the quality of a guideline can be mapped to such fully automated theorem-proving facilities. The medical quality of an actual guideline concerning diabetes mellitus 2 is investigated in this way.

  2. Clinical Decision Making among Dental Students and General Practitioners.

    Science.gov (United States)

    Grembowski, David; And Others

    1989-01-01

    Senior dental students and family dental practitioners were surveyed concerning their choice of pairs of alternative treatments and the technical and patient factors influencing their decisions. Greater agreement in clinical decision-making was found among dentists than among students for all four pairs of alternative services. (MSE)

  3. Clinical decision-making: physicians' preferences and experiences

    Directory of Open Access Journals (Sweden)

    White Martha

    2007-03-01

    Full Text Available Abstract Background Shared decision-making has been advocated; however there are relatively few studies on physician preferences for, and experiences of, different styles of clinical decision-making as most research has focused on patient preferences and experiences. The objectives of this study were to determine 1 physician preferences for different styles of clinical decision-making; 2 styles of clinical decision-making physicians perceive themselves as practicing; and 3 the congruence between preferred and perceived style. In addition we sought to determine physician perceptions of the availability of time in visits, and their role in encouraging patients to look for health information. Methods Cross-sectional survey of a nationally representative sample of U.S. physicians. Results 1,050 (53% response rate physicians responded to the survey. Of these, 780 (75% preferred to share decision-making with their patients, 142 (14% preferred paternalism, and 118 (11% preferred consumerism. 87% of physicians perceived themselves as practicing their preferred style. Physicians who preferred their patients to play an active role in decision-making were more likely to report encouraging patients to look for information, and to report having enough time in visits. Conclusion Physicians tend to perceive themselves as practicing their preferred role in clinical decision-making. The direction of the association cannot be inferred from these data; however, we suggest that interventions aimed at promoting shared decision-making need to target physicians as well as patients.

  4. Grand Challenges in Clinical Decision Support v10

    OpenAIRE

    Sittig, Dean F.; Wright, Adam; Osheroff, Jerome A; Middleton, Blackford; Teich, Jonathan M.; Ash, Joan S.; Campbell, Emily; Bates, David W.

    2007-01-01

    There is a pressing need for high-quality, effective means of designing, developing, presenting, implementing, evaluating, and maintaining all types of clinical decision support capabilities for clinicians, patients and consumers. Using an iterative, consensus-building process we identified a rank-ordered list of the top 10 grand challenges in clinical decision support. This list was created to educate and inspire researchers, developers, funders, and policy-makers. The list of challenges in ...

  5. Automation and rationality in decision-making to replace a sportman at decisive moments

    Directory of Open Access Journals (Sweden)

    JAIME GIL LAFUENTE

    2008-06-01

    Full Text Available Increasingly, the sport entertainment is emerging as an object of study in advanced research centers, as a result of the need to manage the high budgets of sport entities. To win in sports like football or basketball depends on many factors, almost all studied thoroughly. It shows, however, that in one of them, the decision making is hastily and intuitive. It’s the substitution of a player by another one that should enter into the pitch to fulfi ll some tasks that the replaced one, for whatever reason, can’t carry out. The coach is forced, then, to take a decision almost always under ambient pressure and confl ict of sensations often contradictory. In this paper we propose an algorithm easy to use and apply for answer to the following question: is it necessary to replace a player? And if so, on which of them should be replaced.

  6. Driving and dementia: a clinical decision pathway

    OpenAIRE

    Carter, Kirsty; Monaghan, Sophie; O'Brien, John; Teodorczuk, Andrew; Mosimann, Urs; Taylor, John-Paul

    2014-01-01

    Objective This study aimed to develop a pathway to bring together current UK legislation, good clinical practice and appropriate management strategies that could be applied across a range of healthcare settings. Methods The pathway was constructed by a multidisciplinary clinical team based in a busy Memory Assessment Service. A process of successive iteration was used to develop the pathway, with input and refinement provided via survey and small group meetings with individuals from a wide ra...

  7. Driving and dementia: a clinical decision pathway

    OpenAIRE

    Carter, Kirsty; Monaghan, Sophie; O'Brien, John; Teodorczuk, Andrew; Mosimann, Urs Peter; Taylor, John-Paul

    2014-01-01

    OBJECTIVE This study aimed to develop a pathway to bring together current UK legislation, good clinical practice and appropriate management strategies that could be applied across a range of healthcare settings. METHODS The pathway was constructed by a multidisciplinary clinical team based in a busy Memory Assessment Service. A process of successive iteration was used to develop the pathway, with input and refinement provided via survey and small group meetings with individuals fr...

  8. Clinical Decision Making in Renal Pain Management

    OpenAIRE

    Aganovic, Damir; Prcic, Alen; Kulovac, Benjamin; Hadziosmanovic, Osman

    2012-01-01

    Objectives: To determine the optimal medication for the treatment of renal colic using evidence based medicine (EBM) parameters (RR, ARR, NNT, NNH, ARI, RRI). Sample and Methodology: During 2010, an ITT study was conducted on 400 outpatients of the Sarajevo University Clinical Center Urology Clinic in order to investigate renal colic pain relief drugs. Each group consisting of 100 patients was administered either Metamizol amp. i.v., or Diclofenac amp. i.m., or Butylscopolamine amp. i.v., whi...

  9. Risk perception and clinical decision making in primary care

    DEFF Research Database (Denmark)

    Barfoed, Benedicte Marie Lind

    2015-01-01

    Objectives We aim to present new knowledge about different perspectives of health care professionals’ risk perceptions and clinical decision making. Furthermore, we intend to discuss differences between professional and personal risk perceptions and the impact on decisions in terms of both short...... considerations and the specific context. Most research has been focused on understanding of the concepts of risk. However healthcare professionals’ risk perception and personal attitudes also affect their clinical decision-making and risk communication. The differences between health care professionals’ personal...... and professional risk perception and attitudes and the subsequent impact on patients’ decision making have not previously been discussed. Content 1. Peder Halvorsen, MD, Professor, General Practice, Department of Community Medicine, The Arctic University of Norway: Making good decisions: Intuition or...

  10. Better clinical decision making and reducing diagnostic error.

    Science.gov (United States)

    Croskerry, P; Nimmo, G R

    2011-06-01

    A major amount of our time working in clinical practice involves thinking and decision making. Perhaps it is because decision making is such a commonplace activity that it is assumed we can all make effective decisions. However, this is not the case and the example of diagnostic error supports this assertion. Until quite recently there has been a general nihilism about the ability to change the way that we think, but it is now becoming accepted that if we can think about, and understand, our thinking processes we can improve our decision making, including diagnosis. In this paper we review the dual process model of decision making and highlight ways in which decision making can be improved through the application of this model to our day-to-day practice and by the adoption of de-biasing strategies and critical thinking. PMID:21677922

  11. Library Automation as a Source of Management Information. Papers presented at the Clinic on Library Applications of Data Processing (19th, Urbana, IL, April 25-28, 1982).

    Science.gov (United States)

    Lancaster, F. Wilfrid, Ed.

    Papers presented at the 19th Clinic on Library Applications of Data Processing represent a great variety, ranging from a tutorial on management information and decision support systems, through more philosophical discussions of the value of computer-derived information in library management, to studies of the use of automated systems as sources of…

  12. Reducing Diagnostic Error with Computer-Based Clinical Decision Support

    Science.gov (United States)

    Greenes, Robert A.

    2009-01-01

    Information technology approaches to delivering diagnostic clinical decision support (CDS) are the subject of the papers to follow in the proceedings. These will address the history of CDS and present day approaches (Miller), evaluation of diagnostic CDS methods (Friedman), and the role of clinical documentation in supporting diagnostic decision…

  13. Syncope: risk stratification and clinical decision making.

    Science.gov (United States)

    Peeters, Suzanne Y G; Hoek, Amber E; Mollink, Susan M; Huff, J Stephen

    2014-04-01

    Syncope is a common occurrence in the emergency department, accounting for approximately 1% to 3% of presentations. Syncope is best defined as a brief loss of consciousness and postural tone followed by spontaneous and complete recovery. The spectrum of etiologies ranges from benign to life threatening, and a structured approach to evaluating these patients is key to providing care that is thorough, yet cost-effective. This issue reviews the most relevant evidence for managing and risk stratifying the syncope patient, beginning with a focused history, physical examination, electrocardiogram, and tailored diagnostic testing. Several risk stratification decision rules are compared for performance in various scenarios, including how age and associated comorbidities may predict short-term and long-term adverse events. An algorithm for structured, evidence-based care of the syncope patient is included to ensure that patients requiring hospitalization are managed appropriately and those with benign causes are discharged safely. PMID:25105200

  14. Dynamic Clinical Data Mining: Search Engine-Based Decision Support

    OpenAIRE

    Celi, Leo Anthony; Zimolzak, Andrew J; Stone, David J

    2014-01-01

    The research world is undergoing a transformation into one in which data, on massive levels, is freely shared. In the clinical world, the capture of data on a consistent basis has only recently begun. We propose an operational vision for a digitally based care system that incorporates data-based clinical decision making. The system would aggregate individual patient electronic medical data in the course of care; query a universal, de-identified clinical database using modified search engine t...

  15. Decision-making and problem-solving methods in automation technology

    Science.gov (United States)

    Hankins, W. W.; Pennington, J. E.; Barker, L. K.

    1983-01-01

    The state of the art in the automation of decision making and problem solving is reviewed. The information upon which the report is based was derived from literature searches, visits to university and government laboratories performing basic research in the area, and a 1980 Langley Research Center sponsored conferences on the subject. It is the contention of the authors that the technology in this area is being generated by research primarily in the three disciplines of Artificial Intelligence, Control Theory, and Operations Research. Under the assumption that the state of the art in decision making and problem solving is reflected in the problems being solved, specific problems and methods of their solution are often discussed to elucidate particular aspects of the subject. Synopses of the following major topic areas comprise most of the report: (1) detection and recognition; (2) planning; and scheduling; (3) learning; (4) theorem proving; (5) distributed systems; (6) knowledge bases; (7) search; (8) heuristics; and (9) evolutionary programming.

  16. Clinical Decision Support Tools: The Evolution of a Revolution.

    Science.gov (United States)

    Mould, D R; D'Haens, G; Upton, R N

    2016-04-01

    Dashboard systems for clinical decision support integrate data from multiple sources. These systems, the newest in a long line of dose calculators and other decision support tools, utilize Bayesian approaches to fully individualize dosing using information gathered through therapeutic drug monitoring. In the treatment of inflammatory bowel disease patients with infliximab, dashboards may reduce therapeutic failures and treatment costs. The history and future development of modern Bayesian dashboard systems is described. PMID:26785109

  17. The thinking doctor: clinical decision making in contemporary medicine.

    Science.gov (United States)

    Trimble, Michael; Hamilton, Paul

    2016-08-01

    Diagnostic errors are responsible for a significant number of adverse events. Logical reasoning and good decision-making skills are key factors in reducing such errors, but little emphasis has traditionally been placed on how these thought processes occur, and how errors could be minimised. In this article, we explore key cognitive ideas that underpin clinical decision making and suggest that by employing some simple strategies, physicians might be better able to understand how they make decisions and how the process might be optimised. PMID:27481378

  18. Improving clinical decision support using data mining techniques

    Science.gov (United States)

    Burn-Thornton, Kath E.; Thorpe, Simon I.

    1999-02-01

    Physicians, in their ever-demanding jobs, are looking to decision support systems for aid in clinical diagnosis. However, clinical decision support systems need to be of sufficiently high accuracy that they help, rather than hinder, the physician in his/her diagnosis. Decision support systems with accuracies, of patient state determination, of greater than 80 percent, are generally perceived to be sufficiently accurate to fulfill the role of helping the physician. We have previously shown that data mining techniques have the potential to provide the underpinning technology for clinical decision support systems. In this paper, an extension of the work in reverence 2, we describe how changes in data mining methodologies, for the analysis of 12-lead ECG data, improve the accuracy by which data mining algorithms determine which patients are suffering from heart disease. We show that the accuracy of patient state prediction, for all the algorithms, which we investigated, can be increased by up to 6 percent, using the combination of appropriate test training ratios and 5-fold cross-validation. The use of cross-validation greater than 5-fold, appears to reduce the improvement in algorithm classification accuracy gained by the use of this validation method. The accuracy of 84 percent in patient state predictions, obtained using the algorithm OCI, suggests that this algorithm will be capable of providing the required accuracy for clinical decision support systems.

  19. Medical Device Data and Modeling for Clinical Decision Making

    CERN Document Server

    Zaleski, John R

    2010-01-01

    This cutting-edge volume is the first book that provides you with practical guidance on the use of medical device data for bioinformatics modeling purposes. You learn how to develop original methods for communicating with medical devices within healthcare enterprises and assisting with bedside clinical decision making. The book guides in the implementation and use of clinical decision support methods within the context of electronic health records in the hospital environment.This highly valuable reference also teaches budding biomedical engineers and bioinformaticists the practical benefits of

  20. Automated patient and medication payment method for clinical trials

    Directory of Open Access Journals (Sweden)

    Yawn BP

    2013-01-01

    Full Text Available Barbara P Yawn,1 Suzanne Madison,1 Susan Bertram,1 Wilson D Pace,2 Anne Fuhlbrigge,3 Elliot Israel,3 Dawn Littlefield,1 Margary Kurland,1 Michael E Wechsler41Olmsted Medical Center, Department of Research, Rochester, MN, 2UCDHSC, Department of Family Medicine, University of Colorado Health Science Centre, Aurora, CO, 3Brigham and Women's Hospital, Pulmonary and Critical Care Division, Boston, MA, 4National Jewish Medical Center, Division of Pulmonology, Denver, CO, USABackground: Published reports and studies related to patient compensation for clinical trials focus primarily on the ethical issues related to appropriate amounts to reimburse for patient's time and risk burden. Little has been published regarding the method of payment for patient participation. As clinical trials move into widely dispersed community practices and more complex designs, the method of payment also becomes more complex. Here we review the decision process and payment method selected for a primary care-based randomized clinical trial of asthma management in Black Americans.Methods: The method selected is a credit card system designed specifically for clinical trials that allows both fixed and variable real-time payments. We operationalized the study design by providing each patient with two cards, one for reimbursement for study visits and one for payment of medication costs directly to the pharmacies.Results: Of the 1015 patients enrolled, only two refused use of the ClinCard, requesting cash payments for visits and only rarely a weekend or fill-in pharmacist refused to use the card system for payment directly to the pharmacy. Overall, the system has been well accepted by patients and local study teams. The ClinCard administrative system facilitates the fiscal accounting and medication adherence record-keeping by the central teams. Monthly fees are modest, and all 12 study institutional review boards approved use of the system without concern for patient

  1. The role of emotions in clinical reasoning and decision making.

    Science.gov (United States)

    Marcum, James A

    2013-10-01

    What role, if any, should emotions play in clinical reasoning and decision making? Traditionally, emotions have been excluded from clinical reasoning and decision making, but with recent advances in cognitive neuropsychology they are now considered an important component of them. Today, cognition is thought to be a set of complex processes relying on multiple types of intelligences. The role of mathematical logic (hypothetico-deductive thinking) or verbal linguistic intelligence in cognition, for example, is well documented and accepted; however, the role of emotional intelligence has received less attention-especially because its nature and function are not well understood. In this paper, I argue for the inclusion of emotions in clinical reasoning and decision making. To that end, developments in contemporary cognitive neuropsychology are initially examined and analyzed, followed by a review of the medical literature discussing the role of emotions in clinical practice. Next, a published clinical case is reconstructed and used to illustrate the recognition and regulation of emotions played during a series of clinical consultations, which resulted in a positive medical outcome. The paper's main thesis is that emotions, particularly in terms of emotional intelligence as a practical form of intelligence, afford clinical practitioners a robust cognitive resource for providing quality medical care. PMID:23975905

  2. Clinical Chemistry Laboratory Automation in the 21st Century - Amat Victoria curam (Victory loves careful preparation).

    Science.gov (United States)

    Armbruster, David A; Overcash, David R; Reyes, Jaime

    2014-08-01

    The era of automation arrived with the introduction of the AutoAnalyzer using continuous flow analysis and the Robot Chemist that automated the traditional manual analytical steps. Successive generations of stand-alone analysers increased analytical speed, offered the ability to test high volumes of patient specimens, and provided large assay menus. A dichotomy developed, with a group of analysers devoted to performing routine clinical chemistry tests and another group dedicated to performing immunoassays using a variety of methodologies. Development of integrated systems greatly improved the analytical phase of clinical laboratory testing and further automation was developed for pre-analytical procedures, such as sample identification, sorting, and centrifugation, and post-analytical procedures, such as specimen storage and archiving. All phases of testing were ultimately combined in total laboratory automation (TLA) through which all modules involved are physically linked by some kind of track system, moving samples through the process from beginning-to-end. A newer and very powerful, analytical methodology is liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS). LC-MS/MS has been automated but a future automation challenge will be to incorporate LC-MS/MS into TLA configurations. Another important facet of automation is informatics, including middleware, which interfaces the analyser software to a laboratory information systems (LIS) and/or hospital information systems (HIS). This software includes control of the overall operation of a TLA configuration and combines analytical results with patient demographic information to provide additional clinically useful information. This review describes automation relevant to clinical chemistry, but it must be recognised that automation applies to other specialties in the laboratory, e.g. haematology, urinalysis, microbiology. It is a given that automation will continue to evolve in the clinical laboratory

  3. Toward Fully Automated Multicriterial Plan Generation: A Prospective Clinical Study

    Energy Technology Data Exchange (ETDEWEB)

    Voet, Peter W.J., E-mail: p.voet@erasmusmc.nl [Department of Radiation Oncology, Erasmus Medical Center–Daniel den Hoed Cancer Center, Groene Hilledijk 301, Rotterdam 3075EA (Netherlands); Dirkx, Maarten L.P.; Breedveld, Sebastiaan; Fransen, Dennie; Levendag, Peter C.; Heijmen, Ben J.M. [Department of Radiation Oncology, Erasmus Medical Center–Daniel den Hoed Cancer Center, Groene Hilledijk 301, Rotterdam 3075EA (Netherlands)

    2013-03-01

    Purpose: To prospectively compare plans generated with iCycle, an in-house-developed algorithm for fully automated multicriterial intensity modulated radiation therapy (IMRT) beam profile and beam orientation optimization, with plans manually generated by dosimetrists using the clinical treatment planning system. Methods and Materials: For 20 randomly selected head-and-neck cancer patients with various tumor locations (of whom 13 received sequential boost treatments), we offered the treating physician the choice between an automatically generated iCycle plan and a manually optimized plan using standard clinical procedures. Although iCycle used a fixed “wish list” with hard constraints and prioritized objectives, the dosimetrists manually selected the beam configuration and fine tuned the constraints and objectives for each IMRT plan. Dosimetrists were not informed in advance whether a competing iCycle plan was made. The 2 plans were simultaneously presented to the physician, who then selected the plan to be used for treatment. For the patient group, differences in planning target volume coverage and sparing of critical tissues were quantified. Results: In 32 of 33 plan comparisons, the physician selected the iCycle plan for treatment. This highly consistent preference for the automatically generated plans was mainly caused by the improved sparing for the large majority of critical structures. With iCycle, the normal tissue complication probabilities for the parotid and submandibular glands were reduced by 2.4% ± 4.9% (maximum, 18.5%, P=.001) and 6.5% ± 8.3% (maximum, 27%, P=.005), respectively. The reduction in the mean oral cavity dose was 2.8 ± 2.8 Gy (maximum, 8.1 Gy, P=.005). For the swallowing muscles, the esophagus and larynx, the mean dose reduction was 3.3 ± 1.1 Gy (maximum, 9.2 Gy, P<.001). For 15 of the 20 patients, target coverage was also improved. Conclusions: In 97% of cases, automatically generated plans were selected for treatment because of

  4. An Automated Storage and Retrieval System for Clinical Pharmaceutical Research Documents

    Science.gov (United States)

    Weaver, Barbara N.; And Others

    1970-01-01

    The Clinical Documentation Section of Schering Corporation's Medical Information Center has developed an automated document storage and retrieval system capable of generating indexes to all documents in the system, summaries, and reports for management by computer. (MF)

  5. A novel approach to sequence validating protein expression clones with automated decision making

    Directory of Open Access Journals (Sweden)

    Mohr Stephanie E

    2007-06-01

    Full Text Available Abstract Background Whereas the molecular assembly of protein expression clones is readily automated and routinely accomplished in high throughput, sequence verification of these clones is still largely performed manually, an arduous and time consuming process. The ultimate goal of validation is to determine if a given plasmid clone matches its reference sequence sufficiently to be "acceptable" for use in protein expression experiments. Given the accelerating increase in availability of tens of thousands of unverified clones, there is a strong demand for rapid, efficient and accurate software that automates clone validation. Results We have developed an Automated Clone Evaluation (ACE system – the first comprehensive, multi-platform, web-based plasmid sequence verification software package. ACE automates the clone verification process by defining each clone sequence as a list of multidimensional discrepancy objects, each describing a difference between the clone and its expected sequence including the resulting polypeptide consequences. To evaluate clones automatically, this list can be compared against user acceptance criteria that specify the allowable number of discrepancies of each type. This strategy allows users to re-evaluate the same set of clones against different acceptance criteria as needed for use in other experiments. ACE manages the entire sequence validation process including contig management, identifying and annotating discrepancies, determining if discrepancies correspond to polymorphisms and clone finishing. Designed to manage thousands of clones simultaneously, ACE maintains a relational database to store information about clones at various completion stages, project processing parameters and acceptance criteria. In a direct comparison, the automated analysis by ACE took less time and was more accurate than a manual analysis of a 93 gene clone set. Conclusion ACE was designed to facilitate high throughput clone sequence

  6. Feasibility of Using a Large Clinical Data Warehouse to Automate the Selection of Diagnostic Cohorts

    OpenAIRE

    Stephen, Reejis; Boxwala, Aziz; Gertman, Paul

    2003-01-01

    Data from Clinical Data Warehouses (CDWs) can be used for retrospective studies and for benchmarking. However, automated identification of cases from large datasets containing data items in free text fields is challenging. We developed an algorithm for categorizing pediatric patients presenting with respiratory distress into Bronchiolitis, Bacterial pneumonia and Asthma using clinical variables from a CDW. A feasibility study of this approach indicates that case selection may be automated.

  7. Dynamic clinical data mining: search engine-based decision support.

    Science.gov (United States)

    Celi, Leo Anthony; Zimolzak, Andrew J; Stone, David J

    2014-01-01

    The research world is undergoing a transformation into one in which data, on massive levels, is freely shared. In the clinical world, the capture of data on a consistent basis has only recently begun. We propose an operational vision for a digitally based care system that incorporates data-based clinical decision making. The system would aggregate individual patient electronic medical data in the course of care; query a universal, de-identified clinical database using modified search engine technology in real time; identify prior cases of sufficient similarity as to be instructive to the case at hand; and populate the individual patient's electronic medical record with pertinent decision support material such as suggested interventions and prognosis, based on prior outcomes. Every individual's course, including subsequent outcomes, would then further populate the population database to create a feedback loop to benefit the care of future patients. PMID:25600664

  8. AIDSS-HR: An Automated Intelligent Decision Support System for Enhancing the Performance of Employees

    Directory of Open Access Journals (Sweden)

    Nana Yaw Asabere

    2013-08-01

    Full Text Available The performance of employees in an organization is a very important issue for effective delivery and output. Various performance management systems with the aid of Information and Communication Technology (ICT are currently being used by companies. Such systems are most of the time connected and accessible through to the internet/www. Through review of relevant literature and a system development methodology, this paper proposes an Automated Intelligent Decision Support – Human Resource (AIDSS-HR system that seeks to control and manage employee activities by tracking the number of years a staff has been at post, keeping inventory on logistics, analyzing appraisal reports of an individual staff and invoking real time prompts devoid of false alarm. The implementation of AIDSS-HR will improve the performance management of employees and benefit the organization, employees and developing nations as a whole.

  9. Prospects of Automation Agents in Agribusiness (Hop Industry) Decision Support Systems Related to Production, Marketing and Education

    OpenAIRE

    Pavlovic, Martin; Koumboulis, Fotis

    2010-01-01

    The proposed Automation Agents are planed to be applied in a decision support system for a hop industry. However, they represent generalised tools applicable to some extent also to other agribusiness sectors. The proposed AADSS is particularly suited for large agricultural production units, since for small units the decision making process is significantly easier. Of special interest are farms with several plots of different crops, where the global farm resources have to be appropriately dist...

  10. Advancing clinical decision support using lessons from outside of healthcare: an interdisciplinary systematic review

    Directory of Open Access Journals (Sweden)

    Wu Helen W

    2012-08-01

    Full Text Available Abstract Background Greater use of computerized decision support (DS systems could address continuing safety and quality problems in healthcare, but the healthcare field has struggled to implement DS technology. This study surveys DS experience across multiple non-healthcare disciplines for new insights that are generalizable to healthcare provider decisions. In particular, it sought design principles and lessons learned from the other disciplines that could inform efforts to accelerate the adoption of clinical decision support (CDS. Methods Our systematic review drew broadly from non-healthcare databases in the basic sciences, social sciences, humanities, engineering, business, and defense: PsychINFO, BusinessSource Premier, Social Sciences Abstracts, Web of Science, and Defense Technical Information Center. Because our interest was in DS that could apply to clinical decisions, we selected articles that (1 provided a review, overview, discussion of lessons learned, or an evaluation of design or implementation aspects of DS within a non-healthcare discipline and (2 involved an element of human judgment at the individual level, as opposed to decisions that can be fully automated or that are made at the organizational level. Results Clinical decisions share some similarities with decisions made by military commanders, business managers, and other leaders: they involve assessing new situations and choosing courses of action with major consequences, under time pressure, and with incomplete information. We identified seven high-level DS system design features from the non-healthcare literature that could be applied to CDS: providing broad, system-level perspectives; customizing interfaces to specific users and roles; making the DS reasoning transparent; presenting data effectively; generating multiple scenarios covering disparate outcomes (e.g., effective; effective with side effects; ineffective; allowing for contingent adaptations; and facilitating

  11. The Johns Hopkins Hospital Asthma Clinic - An Automated System

    OpenAIRE

    Nichols, Karen J.

    1985-01-01

    The Johns Hopkins Asthma room was chosen for automation in order to act as a prototype for the new Johns Hopkins Hospital Automated Emergency Room. The system is designed to act as a stand alone station. It will provide valuable information in regards to the design, implementation and training of the whole E.R. project. The new system will consist of a series of seven screens that will totally replace the paper form currently being used by the E.R. The screens will be password protected in or...

  12. Justification of automated decision-making: medical explanations as medical arguments.

    OpenAIRE

    Shankar, R.D.; Musen, M. A.

    1999-01-01

    People use arguments to justify their claims. Computer systems use explanations to justify their conclusions. We are developing WOZ, an explanation framework that justifies the conclusions of a clinical decision-support system. WOZ's central component is the explanation strategy that decides what information justifies a claim. The strategy uses Toulmin's argument structure to define pieces of information and to orchestrate their presentation. WOZ uses explicit models that abstract the core as...

  13. An Automated Approach for Ranking Journals to Help in Clinician Decision Support

    OpenAIRE

    Jonnalagadda, Siddhartha R.; Moosavinasab, Soheil; Nath, Chinmoy; Li, Dingcheng; Chute, Christopher G.; Liu, Hongfang

    2014-01-01

    Point of care access to knowledge from full text journal articles supports decision-making and decreases medical errors. However, it is an overwhelming task to search through full text journal articles and find quality information needed by clinicians. We developed a method to rate journals for a given clinical topic, Congestive Heart Failure (CHF). Our method enables filtering of journals and ranking of journal articles based on source journal in relation to CHF. We also obtained a journal p...

  14. Clinical Decision Making of Nurses Working in Hospital Settings

    Directory of Open Access Journals (Sweden)

    Ida Torunn Bjørk

    2011-01-01

    Full Text Available This study analyzed nurses' perceptions of clinical decision making (CDM in their clinical practice and compared differences in decision making related to nurse demographic and contextual variables. A cross-sectional survey was carried out with 2095 nurses in four hospitals in Norway. A 24-item Nursing Decision Making Instrument based on cognitive continuum theory was used to explore how nurses perceived their CDM when meeting an elective patient for the first time. Data were analyzed with descriptive frequencies, t-tests, Chi-Square test, and linear regression. Nurses' decision making was categorized into analytic-systematic, intuitive-interpretive, and quasi-rational models of CDM. Most nurses reported the use of quasi-rational models during CDM thereby supporting the tenet that cognition most often includes properties of both analysis and intuition. Increased use of intuitive-interpretive models of CDM was associated with years in present job, further education, male gender, higher age, and working in predominantly surgical units.

  15. A review of clinical decision-making: Models and current research

    OpenAIRE

    Banning, M

    2007-01-01

    Aims and objectives: The aim of this paper was to review the current literature with respect to clinical decision-making models and the educational application of models to clinical practice. This was achieved by exploring the function and related research of the three available models of clinical decision making: information processing model, the intuitive-humanist model and the clinical decision making model. Background: Clinical decision-making is a unique process that involves the inte...

  16. Priority oral health research identification for clinical decision-making.

    Science.gov (United States)

    Worthington, Helen; Clarkson, Jan; Weldon, Jo

    2015-09-01

    The Cochrane Library is a core resource for clinical decision-making globally, by clinicians, guideline developers, healthcare providers and patients.The publication of Cochrane Library systematic reviews concerning oral health conditions has grown exponentially to over 215 individual titles (as of 20 June 2015) during the past 20 years.Consequently, maintaining updates of the most clinically important reviews to provide up-to-date and accurate sources of evidence for decision-making has become a pressing concern for the editorial group behind their production, Cochrane Oral Health Group.To identify priority research required by oral health decision-makers, the Cochrane OHG embarked on a consultation process across eight defined areas of dentistry (periodontology, operative (including endodontics) and prosthodontics, paediatric dentistry, dental public health, oral and maxillofacial surgery, oral medicine, orthodontics, cleft lip and/or palate) with existing authors (by email), with members of the public (by online survey), and established internationally clinically expert panels for each area of defined area of dentistry to discuss and ratify (by teleconference) a core portfolio of priority evidence to be produced and maintained on the Cochrane Library.The resulting portfolio of priority research encompasses 81 existing titles to be maintained, and an additional 15 new systematic reviews to be developed by the Cochrane OHG in due course.The Cochrane OHG has actively responded to the outcomes of this prioritisation process by allocating resources to primarily supporting the maintenance of identified priority evidence for the Cochrane Library. PMID:26492797

  17. Clinical Chemistry Laboratory Automation in the 21st Century - Amat Victoria curam (Victory loves careful preparation)

    OpenAIRE

    Armbruster, David A; Overcash, David R; Reyes, Jaime

    2014-01-01

    The era of automation arrived with the introduction of the AutoAnalyzer using continuous flow analysis and the Robot Chemist that automated the traditional manual analytical steps. Successive generations of stand-alone analysers increased analytical speed, offered the ability to test high volumes of patient specimens, and provided large assay menus. A dichotomy developed, with a group of analysers devoted to performing routine clinical chemistry tests and another group dedicated to performing...

  18. Cancer diagnostics: decision criteria for marker utilization in the clinic.

    Science.gov (United States)

    Taube, Sheila E; Jacobson, James W; Lively, Tracy G

    2005-01-01

    A new diagnostic tool must pass three major tests before it is adopted for routine clinical use. First, the tool must be robust and reproducible; second, the clinical value of the tool must be proven, i.e. the tool should reliably trigger a clinical decision that results in patient benefit; and, third, the clinical community has to be convinced of the need for this tool and the benefits it affords. Another factor that can influence the adoption of new tools relates to the cost and the vagaries of insurance reimbursement. The Cancer Diagnosis Program (CDP) of the US National Cancer Institute (NCI) launched the Program for the Assessment of Clinical Cancer Tests (PACCT) in 2000 to develop a process for moving the results of new technologies and new understanding of cancer biology more efficiently and effectively into clinical practice. PACCT has developed an algorithm that incorporates the iterative nature of assay development into an evaluation process that includes developers and end users. The effective introduction of new tests into clinical practice has been hampered by a series of common problems that are best described using examples of successes and failures. The successful application of the PACCT algorithm is described in the discussion of the recent development of the OncotypeDX assay and plan for a prospective trial of this assay by the NCI-supported Clinical Trials Cooperative Groups. The assay uses reverse transcription (RT)-PCR evaluation of a set of 16 genes that were shown to strongly associate with the risk of recurrence of breast cancer in women who presented with early stage disease (hormone responsive, and no involvement of the auxiliary lymph nodes). The test is highly reproducible. It provides information to aid the physician and patient in making important clinical decisions, including the aggressiveness of the therapy that should be recommended. A trial is planned to test whether OncotypeDX can be used as a standalone trigger for specific

  19. A Clinical Decision Support System for Breast Cancer Patients

    Science.gov (United States)

    Fernandes, Ana S.; Alves, Pedro; Jarman, Ian H.; Etchells, Terence A.; Fonseca, José M.; Lisboa, Paulo J. G.

    This paper proposes a Web clinical decision support system for clinical oncologists and for breast cancer patients making prognostic assessments, using the particular characteristics of the individual patient. This system comprises three different prognostic modelling methodologies: the clinically widely used Nottingham prognostic index (NPI); the Cox regression modelling and a partial logistic artificial neural network with automatic relevance determination (PLANN-ARD). All three models yield a different prognostic index that can be analysed together in order to obtain a more accurate prognostic assessment of the patient. Missing data is incorporated in the mentioned models, a common issue in medical data that was overcome using multiple imputation techniques. Risk group assignments are also provided through a methodology based on regression trees, where Boolean rules can be obtained expressed with patient characteristics.

  20. Guideline Formalization and Knowledge Representation for Clinical Decision Support

    Directory of Open Access Journals (Sweden)

    Tiago OLIVEIRA

    2012-09-01

    Full Text Available Normal 0 21 false false false EN-US JA X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabla normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:Cambria; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-ansi-language:EN-US;} The prevalence of situations of medical error and defensive medicine in healthcare institutions is a great concern of the medical community. Clinical Practice Guidelines are regarded by most researchers as a way to mitigate theseoccurrences; however, there is a need to make them interactive, easier to update and to deploy. This paper provides a model for Computer-Interpretable Guidelines based on the generic tasks of the clinical process, devised to be included in the framework of a Clinical Decision Support System. Aiming to represent medical recommendations in a simple and intuitive way. Hence, this work proposes a knowledge representation formalism that uses an Extension to Logic Programming to handle incomplete information. This model is used to represent different cases of missing, conflicting and inexact information with the aid of a method to quantify its quality. The integration of the guideline model with the knowledge representation formalism yields a clinical decision model that relies on the development of multiple information scenarios and the exploration of different clinical hypotheses.

  1. An automated approach for ranking journals to help in clinician decision support.

    Science.gov (United States)

    Jonnalagadda, Siddhartha R; Moosavinasab, Soheil; Nath, Chinmoy; Li, Dingcheng; Chute, Christopher G; Liu, Hongfang

    2014-01-01

    Point of care access to knowledge from full text journal articles supports decision-making and decreases medical errors. However, it is an overwhelming task to search through full text journal articles and find quality information needed by clinicians. We developed a method to rate journals for a given clinical topic, Congestive Heart Failure (CHF). Our method enables filtering of journals and ranking of journal articles based on source journal in relation to CHF. We also obtained a journal priority score, which automatically rates any journal based on its importance to CHF. Comparing our ranking with data gathered by surveying 169 cardiologists, who publish on CHF, our best Multiple Linear Regression model showed a correlation of 0.880, based on five-fold cross validation. Our ranking system can be extended to other clinical topics. PMID:25954382

  2. Clinical Decision Support Knowledge Management: Strategies for Success.

    Science.gov (United States)

    Khalifa, Mohamed; Alswailem, Osama

    2015-01-01

    Clinical Decision Support Systems have been shown to increase quality of care, patient safety, improve adherence to guidelines for prevention and treatment, and avoid medication errors. Such systems depend mainly on two types of content; the clinical information related to patients and the medical knowledge related to the specialty that informs the system rules and alerts. At King Faisal Specialist Hospital and Research Center, Saudi Arabia, the Health Information Technology Affairs worked on identifying best strategies and recommendations for successful CDSS knowledge management. A review of literature was conducted to identify main areas of challenges and factors of success. A qualitative survey was used over six months' duration to collect opinions, experiences and suggestions from both IT and healthcare professionals. Recommendations were categorized into ten main topics that should be addressed during the development and implementation of CDSS knowledge management tools in the hospital. PMID:26152955

  3. Future of Earthquake Early Warning: Quantifying Uncertainty and Making Fast Automated Decisions for Applications

    Science.gov (United States)

    Wu, Stephen

    Earthquake early warning (EEW) systems have been rapidly developing over the past decade. Japan Meteorological Agency (JMA) has an EEW system that was operating during the 2011 M9 Tohoku earthquake in Japan, and this increased the awareness of EEW systems around the world. While longer-time earthquake prediction still faces many challenges to be practical, the availability of shorter-time EEW opens up a new door for earthquake loss mitigation. After an earthquake fault begins rupturing, an EEW system utilizes the first few seconds of recorded seismic waveform data to quickly predict the hypocenter location, magnitude, origin time and the expected shaking intensity level around the region. This early warning information is broadcast to different sites before the strong shaking arrives. The warning lead time of such a system is short, typically a few seconds to a minute or so, and the information is uncertain. These factors limit human intervention to activate mitigation actions and this must be addressed for engineering applications of EEW. This study applies a Bayesian probabilistic approach along with machine learning techniques and decision theories from economics to improve different aspects of EEW operation, including extending it to engineering applications. Existing EEW systems are often based on a deterministic approach. Often, they assume that only a single event occurs within a short period of time, which led to many false alarms after the Tohoku earthquake in Japan. This study develops a probability-based EEW algorithm based on an existing deterministic model to extend the EEW system to the case of concurrent events, which are often observed during the aftershock sequence after a large earthquake. To overcome the challenge of uncertain information and short lead time of EEW, this study also develops an earthquake probability-based automated decision-making (ePAD) framework to make robust decision for EEW mitigation applications. A cost-benefit model that

  4. Towards Automation 2.0: A Neurocognitive Model for Environment Recognition, Decision-Making, and Action Execution

    Directory of Open Access Journals (Sweden)

    Zucker Gerhard

    2011-01-01

    Full Text Available The ongoing penetration of building automation by information technology is by far not saturated. Today's systems need not only be reliable and fault tolerant, they also have to regard energy efficiency and flexibility in the overall consumption. Meeting the quality and comfort goals in building automation while at the same time optimizing towards energy, carbon footprint and cost-efficiency requires systems that are able to handle large amounts of information and negotiate system behaviour that resolves conflicting demands—a decision-making process. In the last years, research has started to focus on bionic principles for designing new concepts in this area. The information processing principles of the human mind have turned out to be of particular interest as the mind is capable of processing huge amounts of sensory data and taking adequate decisions for (re-actions based on these analysed data. In this paper, we discuss how a bionic approach can solve the upcoming problems of energy optimal systems. A recently developed model for environment recognition and decision-making processes, which is based on research findings from different disciplines of brain research is introduced. This model is the foundation for applications in intelligent building automation that have to deal with information from home and office environments. All of these applications have in common that they consist of a combination of communicating nodes and have many, partly contradicting goals.

  5. Are patient decision aids the best way to improve clinical decision making? Report of the IPDAS Symposium.

    Science.gov (United States)

    Holmes-Rovner, Margaret; Nelson, Wendy L; Pignone, Michael; Elwyn, Glyn; Rovner, David R; O'Connor, Annette M; Coulter, Angela; Correa-de-Araujo, Rosaly

    2007-01-01

    This article reports on the International Patient Decision Aid Standards Symposium held in 2006 at the annual meeting of the Society for Medical Decision Making in Cambridge, Massachusetts. The symposium featured a debate regarding the proposition that "decision aids are the best way to improve clinical decision making.'' The formal debate addressed the theoretical problem of the appropriate gold standard for an improved decision, efficacy of decision aids, and prospects for implementation. Audience comments and questions focused on both theory and practice: the often unacknowledged roots of decision aids in expected utility theory and the practical problems of limited patient decision aid implementation in health care. The participants' vote on the proposition was approximately half for and half against. PMID:17873257

  6. Endodontic retreatment. Aspects of decision making and clinical outcome.

    Science.gov (United States)

    Kvist, T

    2001-01-01

    regardless of assessment method. Compared with Standard gamble Visual Analogue Scale systematically produced lower ratings. U-values were found to change considerably in both the short and long-term. Any significant correlation between endodontists' U-values and retreatment prescriptions could not be demonstrated. Surgical and nonsurgical retreatment were randomly assigned to 95 "failed" root filled teeth in 92 patients. Cases were followed clinically and radiographically for four years postoperatively. At the 12-month recall a statistically significant higher healing rate was observed for teeth retreated surgically. At the final 48-month recall no systematic difference was detected. Patients were found to be more subject to postoperative discomfort when teeth were retreated surgically compared with nonsurgically. Consequently, surgical retreatment tended to be associated with higher indirect costs than a nonsurgically approach. In the final part of the thesis it is argued that retreatment decision making in everyday clinical practice normally should be based on simple principles. It is suggested that in order to achieve the best overall consequence a periapical lesion in a root filled tooth that is not expected to heal should be retreated. Arguments to withhold retreatment should be based on (i) respect for patient autonomy, (ii) retreatment risks or (iii) retreatment costs. PMID:11288682

  7. Clinical implementation of RNA signatures for pharmacogenomic decision-making

    Directory of Open Access Journals (Sweden)

    Tang W

    2011-09-01

    Full Text Available Weihua Tang1, Zhiyuan Hu2, Hind Muallem1, Margaret L Gulley1,21Department of Pathology and Laboratory Medicine, 2Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, NC, USAAbstract: RNA profiling is increasingly used to predict drug response, dose, or toxicity based on analysis of drug pharmacokinetic or pharmacodynamic pathways. Before implementing multiplexed RNA arrays in clinical practice, validation studies are carried out to demonstrate sufficient evidence of analytic and clinical performance, and to establish an assay protocol with quality assurance measures. Pathologists assure quality by selecting input tissue and by interpreting results in the context of the input tissue as well as the technologies that were used and the clinical setting in which the test was ordered. A strength of RNA profiling is the array-based measurement of tens to thousands of RNAs at once, including redundant tests for critical analytes or pathways to promote confidence in test results. Instrument and reagent manufacturers are crucial for supplying reliable components of the test system. Strategies for quality assurance include careful attention to RNA preservation and quality checks at pertinent steps in the assay protocol, beginning with specimen collection and proceeding through the various phases of transport, processing, storage, analysis, interpretation, and reporting. Specimen quality is checked by probing housekeeping transcripts, while spiked and exogenous controls serve as a check on analytic performance of the test system. Software is required to manipulate abundant array data and present it for interpretation by a laboratory physician who reports results in a manner facilitating therapeutic decision-making. Maintenance of the assay requires periodic documentation of personnel competency and laboratory proficiency. These strategies are shepherding genomic arrays into clinical settings to provide added

  8. Clinical decision support for perioperative information management systems.

    Science.gov (United States)

    Wanderer, Jonathan P; Ehrenfeld, Jesse M

    2013-12-01

    Clinical decision support (CDS) systems are being used to optimize the increasingly complex care that our health care system delivers. These systems have become increasingly important in the delivery of perioperative care for patients undergoing cardiac, thoracic, and vascular procedures. The adoption of perioperative information management systems (PIMS) has allowed these technologies to enter the operating room and support the clinical work flow of anesthesiologists and operational processes. Constructing effective CDS systems necessitates an understanding of operative work flow and technical considerations as well as achieving integration with existing information systems. In this review, we describe published examples of CDS for PIMS, including support for cardiopulmonary bypass separation physiological alarms, β-blocker guideline adherence, enhanced revenue capture for arterial line placement, and detection of hemodynamic monitoring gaps. Although these and other areas are amenable to CDS systems, the challenges of latency and data reliability represent fundamental limitations on the potential application of these tools to specific types of clinical issues. Ultimately, we expect that CDS will remain an important tool in our efforts to optimize the quality of care delivered. PMID:23690340

  9. Checking the Quality of Clinical Guidelines using Automated Reasoning Tools

    OpenAIRE

    Hommersom, A.J.; Lucas, P.J.F.; Bommel, P.

    2008-01-01

    Requirements about the quality of clinical guidelines can be represented by schemata borrowed from the theory of abductive diagnosis, using temporal logic to model the time-oriented aspects expressed in a guideline. Previously, we have shown that these requirements can be verified using interactive theorem proving techniques. In this paper, we investigate how this approach can be mapped to the facilities of a resolution-based theorem prover, Otter, and a complementary program that searches fo...

  10. Automated Predictive Diagnosis (APD): A 3-tiered shell for building expert systems for automated predictions and decision making

    Science.gov (United States)

    Steib, Michael

    1991-01-01

    The APD software features include: On-line help, Three level architecture, (Logic environments, Setup/Application environment, Data environment), Explanation capability, and File handling. The kinds of experimentation and record keeping that leads to effective expert systems is facilitated by: (1) a library of inferencing modules (in the logic environment); (2) an explanation capability which reveals logic strategies to users; (3) automated file naming conventions; (4) an information retrieval system; and (5) on-line help. These aid with effective use of knowledge, debugging and experimentation. Since the APD software anticipates the logical rules becoming complicated, it is embedded in a production system language (CLIPS) to insure the full power of the production system paradigm of CLIPS and availability of the procedural language C. The development is discussed of the APD software and three example applications: toy, experimental, and operational prototype for submarine maintenance predictions.

  11. Automated validation of patient safety clinical incident classification: macro analysis.

    Science.gov (United States)

    Gupta, Jaiprakash; Patrick, Jon

    2013-01-01

    Patient safety is the buzz word in healthcare. Incident Information Management System (IIMS) is electronic software that stores clinical mishaps narratives in places where patients are treated. It is estimated that in one state alone over one million electronic text documents are available in IIMS. In this paper we investigate the data density available in the fields entered to notify an incident and the validity of the built in classification used by clinician to categories the incidents. Waikato Environment for Knowledge Analysis (WEKA) software was used to test the classes. Four statistical classifier based on J48, Naïve Bayes (NB), Naïve Bayes Multinominal (NBM) and Support Vector Machine using radial basis function (SVM_RBF) algorithms were used to validate the classes. The data pool was 10,000 clinical incidents drawn from 7 hospitals in one state in Australia. In first part of the study 1000 clinical incidents were selected to determine type and number of fields worth investigating and in the second part another 5448 clinical incidents were randomly selected to validate 13 clinical incident types. Result shows 74.6% of the cells were empty and only 23 fields had content over 70% of the time. The percentage correctly classified classes on four algorithms using categorical dataset ranged from 42 to 49%, using free-text datasets from 65% to 77% and using both datasets from 72% to 79%. Kappa statistic ranged from 0.36 to 0.4. for categorical data, from 0.61 to 0.74. for free-text and from 0.67 to 0.77 for both datasets. Similar increases in performance in the 3 experiments was noted on true positive rate, precision, F-measure and area under curve (AUC) of receiver operating characteristics (ROC) scores. The study demonstrates only 14 of 73 fields in IIMS have data that is usable for machine learning experiments. Irrespective of the type of algorithms used when all datasets are used performance was better. Classifier NBM showed best performance. We think the

  12. Optimizing perioperative decision making: improved information for clinical workflow planning.

    Science.gov (United States)

    Doebbeling, Bradley N; Burton, Matthew M; Wiebke, Eric A; Miller, Spencer; Baxter, Laurence; Miller, Donald; Alvarez, Jorge; Pekny, Joseph

    2012-01-01

    Perioperative care is complex and involves multiple interconnected subsystems. Delayed starts, prolonged cases and overtime are common. Surgical procedures account for 40-70% of hospital revenues and 30-40% of total costs. Most planning and scheduling in healthcare is done without modern planning tools, which have potential for improving access by assisting in operations planning support. We identified key planning scenarios of interest to perioperative leaders, in order to examine the feasibility of applying combinatorial optimization software solving some of those planning issues in the operative setting. Perioperative leaders desire a broad range of tools for planning and assessing alternate solutions. Our modeled solutions generated feasible solutions that varied as expected, based on resource and policy assumptions and found better utilization of scarce resources. Combinatorial optimization modeling can effectively evaluate alternatives to support key decisions for planning clinical workflow and improving care efficiency and satisfaction. PMID:23304284

  13. Details of a Successful Clinical Decision Support System

    Science.gov (United States)

    Friedlin, Jeff; Dexter, Paul R.; Overhage, J. Marc

    2007-01-01

    Computerized physician order entry (CPOE) with clinical decision support (CDS) is regarded as one of the most effective ways to improve the quality of health care and increase patient safety. As electronic medical records become more available, such systems will increasingly become the method of choice to achieve these goals. Creating a CPOE/CDS system is a complex task, and some fail despite time consuming and expensive development. The CPOE system at the Regenstrief Institute incorporates sophisticated CDS and is one of the oldest and most successful in the U.S. Many years in development, it is currently used by hundreds of providers. Our well established, successful system can serve as a template or model for the future development of similar systems. We recently completed a full analysis of our CPOE/CDS system and present details of its structure, functionality and contents. PMID:18693837

  14. Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice.

    Science.gov (United States)

    Hajjaj, F M; Salek, M S; Basra, M K A; Finlay, A Y

    2010-05-01

    This article reviews an aspect of daily clinical practice which is of critical importance in virtually every clinical consultation, but which is seldom formally considered. Non-clinical influences on clinical decision-making profoundly affect medical decisions. These influences include patient-related factors such as socioeconomic status, quality of life and patient's expectations and wishes, physician-related factors such as personal characteristics and interaction with their professional community, and features of clinical practice such as private versus public practice as well as local management policies. This review brings together the different strands of knowledge concerning non-clinical influences on clinical decision-making. This aspect of decision-making may be the biggest obstacle to the reality of practising evidence-based medicine. It needs to be understood in order to develop clinical strategies that will facilitate the practice of evidence-based medicine. PMID:20436026

  15. Forms of Knowledge Incorporated in Clinical Decision-making among Newly-Graduated Nurses: A Metasynthesis

    DEFF Research Database (Denmark)

    Voldbjerg, Siri; Elgaard Sørensen, Erik; Grønkjær, Mette;

    2013-01-01

    Clinical-decision-making is of decisive importance to how evidence-based practice is put into practice. Schools of Nursing have a responsibility to teach and train nursing students to make clinical decisions within a frame of evidence-based practice. Clinical decision-making among nurses has been...... knowledge that informs clinical decision-making among newly-graduated nurses. Qualitative studies were retrieved from CINAHL, PubMed, SCOPE, ERIC and GOOGLE-Scholar and subsequently selected by pre-defined inclusion criteria and critically appraised using CASP. Metaphors identified in the analytical process...... will contribute to theory development and have implications for clinical and educational practice regarding the professional development of clinical decision making within a frame of evidence-based practice. The presentation highlights the main findings from the metasynthesis and provides perspectives...

  16. Critiquing Physician Decision Making Using Data from Automated Medical Records: Assessing the Limitations

    OpenAIRE

    Van Der Lei, Johan; Musen, Mark A.; van der Does, Emiel; Manintveld, Arie J.

    1990-01-01

    This paper describes the evaluation of a critiquing system, HYPERCRITIC, that relies on automated medical records for its data input. The purpose of HYPERCRITIC is to offer comments to general practitioners on their treatment of hypertension. HYPERCRITIC has access to the data stored in a primary-care information system that supports a fully automated medical record. Medical records of 20 patients with hypertension were submitted to both physicians and HYPERCRITIC. The critique generated by t...

  17. Improving Clinical Decisions on T2DM Patients Integrating Clinical, Administrative and Environmental Data.

    Science.gov (United States)

    Segagni, Daniele; Sacchi, Lucia; Dagliati, Arianna; Tibollo, Valentina; Leporati, Paola; De Cata, Pasqale; Chiovato, Luca; Bellazzi, Riccardo

    2015-01-01

    This work describes an integrated informatics system developed to collect and display clinically relevant data that can inform physicians and researchers about Type 2 Diabetes Mellitus (T2DM) patient clinical pathways and therapy adherence. The software we developed takes data coming from the electronic medical record (EMR) of the IRCCS Fondazione Maugeri (FSM) hospital of Pavia, Italy, and combines the data with administrative, pharmacy drugs (purchased from the local healthcare agency (ASL) of the Pavia area), and open environmental data of the same region. By using different use cases, we explain the importance of gathering and displaying the data types through a single informatics tool: the use of the tool as a calculator of risk factors and indicators to improve current detection of T2DM, a generator of clinical pathways and patients' behaviors from the point of view of the hospital care management, and a decision support tool for follow-up visits. The results of the performed data analysis report how the use of the dashboard displays meaningful clinical decisions in treating complex chronic diseases and might improve health outcomes. PMID:26262138

  18. The Clinical Utility of Automated Breast Volume Scanner: A Pilot Study of 139 Cases

    OpenAIRE

    Kim, Young Wook; Kim, Seon Kwang; Youn, Hyun Jo; Choi, Eun Jung; Jung, Sung Hoo

    2013-01-01

    Purpose The aim of this study is to evaluate the clinical utility of automated breast volume scanner (ABVS) for detecting and diagnosing the breast lesions. Methods From December 2010 to January 2012, bilateral whole breast examinations were performed with ABVS for 139 women. Based on the Breast Imaging Reporting and Data System (BI-RADS) categories, the breast lesions were evaluated on coronal multiplanar reconstruction images using the ABVS workstation. Then, the imaging results were compar...

  19. Automated Information Extraction of Key Trial Design Elements from Clinical Trial Publications

    OpenAIRE

    de Bruijn, Berry; Carini, Simona; Kiritchenko, Svetlana; Martin, Joel; Sim, Ida

    2008-01-01

    Clinical trials are one of the most valuable sources of scientific evidence for improving the practice of medicine. The Trial Bank project aims to improve structured access to trial findings by including formalized trial information into a knowledge base. Manually extracting trial information from published articles is costly, but automated information extraction techniques can assist. The current study highlights a single architecture to extract a wide array of information elements from full...

  20. A semi-automated tool for treatment plan-quality evaluation and clinical trial quality assurance

    Science.gov (United States)

    Wang, Jiazhou; Chen, Wenzhou; Studenski, Matthew; Cui, Yunfeng; Lee, Andrew J.; Xiao, Ying

    2013-07-01

    The goal of this work is to develop a plan-quality evaluation program for clinical routine and multi-institutional clinical trials so that the overall evaluation efficiency is improved. In multi-institutional clinical trials evaluating the plan quality is a time-consuming and labor-intensive process. In this note, we present a semi-automated plan-quality evaluation program which combines MIMVista, Java/MATLAB, and extensible markup language (XML). More specifically, MIMVista is used for data visualization; Java and its powerful function library are implemented for calculating dosimetry parameters; and to improve the clarity of the index definitions, XML is applied. The accuracy and the efficiency of the program were evaluated by comparing the results of the program with the manually recorded results in two RTOG trials. A slight difference of about 0.2% in volume or 0.6 Gy in dose between the semi-automated program and manual recording was observed. According to the criteria of indices, there are minimal differences between the two methods. The evaluation time is reduced from 10-20 min to 2 min by applying the semi-automated plan-quality evaluation program.

  1. A semi-automated tool for treatment plan-quality evaluation and clinical trial quality assurance

    International Nuclear Information System (INIS)

    The goal of this work is to develop a plan-quality evaluation program for clinical routine and multi-institutional clinical trials so that the overall evaluation efficiency is improved. In multi-institutional clinical trials evaluating the plan quality is a time-consuming and labor-intensive process. In this note, we present a semi-automated plan-quality evaluation program which combines MIMVista, Java/MATLAB, and extensible markup language (XML). More specifically, MIMVista is used for data visualization; Java and its powerful function library are implemented for calculating dosimetry parameters; and to improve the clarity of the index definitions, XML is applied. The accuracy and the efficiency of the program were evaluated by comparing the results of the program with the manually recorded results in two RTOG trials. A slight difference of about 0.2% in volume or 0.6 Gy in dose between the semi-automated program and manual recording was observed. According to the criteria of indices, there are minimal differences between the two methods. The evaluation time is reduced from 10–20 min to 2 min by applying the semi-automated plan-quality evaluation program. (note)

  2. Monitoring, accounting and automated decision support for the ALICE experiment based on the MonALISA framework

    CERN Document Server

    Cirstoiu, C; Betev, L; Saiz, P; Peters, A J; Muraru, A; Voicu, R; Legrand, I

    2007-01-01

    We are developing a general purpose monitoring system for the ALICE experiment, based on the MonALISA framework. MonALISA (Monitoring Agents using a Large Integrated Services Architecture) is a fully distributed system with no single point of failure that is able to collect, store monitoring information and present it as significant perspectives and synthetic views on the status and the trends of the entire system. Furthermore, agents can use it for taking automated operational decisions. Monitoring information is gathered locally from all the components running in each site. The entire flow of information is aggregated on site level by a MonALISA service and then collected and presented in various forms by a central MonALISA Repository. Based on this information, other services take operational decisions such as alerts, triggers, service restarts and automatic production job or transfer submissions. The system monitors all the components: computer clusters (all major parameters of each computing node), jobs ...

  3. Automated Extraction and Amplification for Direct Detection of Mycobacterium tuberculosis Complex in Various Clinical Samples▿

    OpenAIRE

    Simonnet, Christine; Lacoste, Vincent; Drogoul, Anne Sophie; Rastogi, Nalin

    2011-01-01

    With the incidence of culture-positive tuberculosis (TB) cases at 25.3 per 100,000 and a 25% rate of TB/HIV coinfection, the TB incidence in French Guiana is the highest of all French regions. In this context, there is an urgent need for simple, automated systems for molecular diagnosis of TB that can be adapted to small laboratories. Introduction of a nuclear amplification test in a routine clinical laboratory is an additional expense, and its cost-effectiveness and clinical utility need to b...

  4. Impact of the introduction of an automated microbiologic system on the clinical outcomes of bloodstream infections caused by Enterobacteriaceae strains

    Directory of Open Access Journals (Sweden)

    Luciana Azevedo Callefi

    2013-01-01

    Full Text Available INTRODUCTION: Enterobacteriaceae strains are a leading cause of bloodstream infections (BSI. The aim of this study is to assess differences in clinical outcomes of patients with BSI caused by Enterobacteriaceae strains before and after introduction of an automated microbiologic system by the microbiology laboratory. METHODS: We conducted a retrospective cohort study aimed to evaluate the impact of the introduction of an automated microbiologic system (Phoenix(tm automated microbiology system, Becton, Dickinson and Company (BD - Diagnostic Systems, Sparks, MD, USA on the outcomes of BSIs caused by Enterobacteriaceae strains. The study was undertaken at Hospital São Paulo, a 750-bed teaching hospital in São Paulo, Brazil. Patients with BSI caused by Enterobacteriaceae strains before the introduction of the automated system were compared with patients with BSI caused by the same pathogens after the introduction of the automated system with regard to treatment adequacy, clinical cure/improvement and 14- and 28-day mortality rates. RESULTS: We evaluated 90 and 106 patients in the non-automated and automated testing periods, respectively. The most prevalent species in both periods were Klebsiella spp. and Proteus spp. Clinical cure/improvement occurred in 70% and 67.9% in non-automated and automated period, respectively (p=0.75. 14-day mortality rates were 22.2% and 30% (p=0.94 and 28-day mortality rates were 24.5% and 40.5% (p= 0.12. There were no significant differences between the two testing periods with regard to treatment adequacy, clinical cure/improvement and 14- and 28-day mortality rates. CONCLUSIONS: Introduction of the BD Phoenix(tm automated microbiology system did not impact the clinical outcomes of BSIs caused by Enterobacteriaceae strains in our setting.

  5. Clinical decision making in restorative dentistry, endodontics, and antibiotic prescription.

    Science.gov (United States)

    Zadik, Yehuda; Levin, Liran

    2008-01-01

    The purpose of this study was to evaluate the influence of geographic location of graduation (Israel, Eastern Europe, Latin America) on decision making regarding management of dental caries, periapical lesions, and antibiotic prescribing routines. A questionnaire was given to ninety-eight general practitioners regarding demographic and work habits. Photographs of lesions were shown on a screen. Participants reported recommended treatment and whether they would routinely prescribe antibiotics following regular endodontic treatment, retreatment, and impacted third molar surgical extraction in healthy patients. There was a 94 percent (n=92) response rate, of which eighty-five responses were used in the data analysis. Surgical treatment of asymptomatic enamel caries lesions was not recommended by most of the subjects, and surgery was recommended for DEJ caries lesions in low or moderate caries risk patients, both without significant differences between geographic regions of dental school graduation. Israelis had a lower frequency of retreatment in asymptomatic teeth that demonstrated periapical radiolucency with post restoration (without crown) compared to Latin Americans and East Europeans. Most of the participants would not retreat asymptomatic teeth that demonstrated periapical radiolucency with post and crown. After third molar surgery, 46 percent of participants routinely prescribed antibiotics. Significantly more Latin American graduates prescribed antibiotics following endodontic treatment, retreatment, and third molar extractions (p<0.05). Overmedication (antibiotics) and overtreatment (caries) among young practitioners reflect failure of undergraduate education in proper use of antibiotics and management of the carious lesions according to the patient's clinical presentation and caries risk assessment rather than routinely undertaking surgical caries treatment. PMID:18172239

  6. Automated astatination of biomolecules - a stepping stone towards multicenter clinical trials

    DEFF Research Database (Denmark)

    Aneheim, Emma; Albertsson, Per; Bäck, Tom; Jensen, Holger; Palm, Stig; Lindegren, Sture

    2015-01-01

    vector, which can guide the radiation to the cancer cells. Consequently, an appropriate method is required for coupling the nuclide to the vector. To increase the availability of astatine-211 radiopharmaceuticals for targeted alpha therapy, their production should be automated. Here, we present a method......To facilitate multicentre clinical studies on targeted alpha therapy, it is necessary to develop an automated, on-site procedure for conjugating rare, short-lived, alpha-emitting radionuclides to biomolecules. Astatine-211 is one of the few alpha-emitting nuclides with appropriate chemical and...... challenging, alpha-emitting radionuclide. In this work, we describe the process platform, and we demonstrate the production of both astaine-211, for preclinical use, and astatine-211 labelled antibodies....

  7. SANDS: a service-oriented architecture for clinical decision support in a National Health Information Network.

    Science.gov (United States)

    Wright, Adam; Sittig, Dean F

    2008-12-01

    In this paper, we describe and evaluate a new distributed architecture for clinical decision support called SANDS (Service-oriented Architecture for NHIN Decision Support), which leverages current health information exchange efforts and is based on the principles of a service-oriented architecture. The architecture allows disparate clinical information systems and clinical decision support systems to be seamlessly integrated over a network according to a set of interfaces and protocols described in this paper. The architecture described is fully defined and developed, and six use cases have been developed and tested using a prototype electronic health record which links to one of the existing prototype National Health Information Networks (NHIN): drug interaction checking, syndromic surveillance, diagnostic decision support, inappropriate prescribing in older adults, information at the point of care and a simple personal health record. Some of these use cases utilize existing decision support systems, which are either commercially or freely available at present, and developed outside of the SANDS project, while other use cases are based on decision support systems developed specifically for the project. Open source code for many of these components is available, and an open source reference parser is also available for comparison and testing of other clinical information systems and clinical decision support systems that wish to implement the SANDS architecture. The SANDS architecture for decision support has several significant advantages over other architectures for clinical decision support. The most salient of these are: PMID:18434256

  8. Comparison of Clinical and Automated Breast Density Measurements: Implications for Risk Prediction and Supplemental Screening.

    Science.gov (United States)

    Brandt, Kathleen R; Scott, Christopher G; Ma, Lin; Mahmoudzadeh, Amir P; Jensen, Matthew R; Whaley, Dana H; Wu, Fang Fang; Malkov, Serghei; Hruska, Carrie B; Norman, Aaron D; Heine, John; Shepherd, John; Pankratz, V Shane; Kerlikowske, Karla; Vachon, Celine M

    2016-06-01

    Purpose To compare the classification of breast density with two automated methods, Volpara (version 1.5.0; Matakina Technology, Wellington, New Zealand) and Quantra (version 2.0; Hologic, Bedford, Mass), with clinical Breast Imaging Reporting and Data System (BI-RADS) density classifications and to examine associations of these measures with breast cancer risk. Materials and Methods In this study, 1911 patients with breast cancer and 4170 control subjects matched for age, race, examination date, and mammography machine were evaluated. Participants underwent mammography at Mayo Clinic or one of four sites within the San Francisco Mammography Registry between 2006 and 2012 and provided informed consent or a waiver for research, in compliance with HIPAA regulations and institutional review board approval. Digital mammograms were retrieved a mean of 2.1 years (range, 6 months to 6 years) before cancer diagnosis, with the corresponding clinical BI-RADS density classifications, and Volpara and Quantra density estimates were generated. Agreement was assessed with weighted κ statistics among control subjects. Breast cancer associations were evaluated with conditional logistic regression, adjusted for age and body mass index. Odds ratios, C statistics, and 95% confidence intervals (CIs) were estimated. Results Agreement between clinical BI-RADS density classifications and Volpara and Quantra BI-RADS estimates was moderate, with κ values of 0.57 (95% CI: 0.55, 0.59) and 0.46 (95% CI: 0.44, 0.47), respectively. Differences of up to 14% in dense tissue classification were found, with Volpara classifying 51% of women as having dense breasts, Quantra classifying 37%, and clinical BI-RADS assessment used to classify 43%. Clinical and automated measures showed similar breast cancer associations; odds ratios for extremely dense breasts versus scattered fibroglandular densities were 1.8 (95% CI: 1.5, 2.2), 1.9 (95% CI: 1.5, 2.5), and 2.3 (95% CI: 1.9, 2.8) for Volpara, Quantra

  9. A Novel Approach to Sequence Validating Protein Expression Clones with Automated Decision Making

    OpenAIRE

    Mohr Stephanie E; Zuo Dongmei; Hu Yanhui; Rolfs Andreas; Taycher Elena; Williamson Janice; LaBaer Joshua

    2007-01-01

    Abstract Background Whereas the molecular assembly of protein expression clones is readily automated and routinely accomplished in high throughput, sequence verification of these clones is still largely performed manually, an arduous and time consuming process. The ultimate goal of validation is to determine if a given plasmid clone matches its reference sequence sufficiently to be "acceptable" for use in protein expression experiments. Given the accelerating increase in availability of tens ...

  10. RECOVER: An Automated, Cloud-Based Decision Support System for Post-Fire Rehabilitation Planning

    OpenAIRE

    Schnase, J. L.; Carroll, M. L.; K. T. Weber; Brown, M. E.; Gill, R. L.; M. Wooten; May, J.; Serr, K.; Smith, E.; R. Goldsby; K. Newtoff; Bradford, K.; Doyle, C; Volker, E.; Weber, S

    2014-01-01

    RECOVER is a site-specific decision support system that automatically brings together in a single analysis environment the information necessary for post-fire rehabilitation decision-making. After a major wildfire, law requires that the federal land management agencies certify a comprehensive plan for public safety, burned area stabilization, resource protection, and site recovery. These burned area emergency response (BAER) plans are a crucial part of our national response to wildfi...

  11. The cognitive processes underpinning clinical decision in triage assessment: a theoretical conundrum?

    Science.gov (United States)

    Noon, Amy J

    2014-01-01

    High quality clinical decision-making (CDM) has been highlighted as a priority across the nursing profession. Triage nurses, in the Accident and Emergency (A&E) department, work in considerable levels of uncertainty and require essential skills including: critical thinking, evaluation and decision-making. The content of this paper aims to promote awareness of how triage nurses make judgements and decisions in emergency situations. By exploring relevant literature on clinical judgement and decision-making theory, this paper demonstrates the importance of high quality decision-making skills underpinning the triage nurse's role. Having an awareness of how judgements and decisions are made is argued as essential, in a time where traditional nurse boundaries and responsibilities are never more challenged. It is hoped that the paper not only raises this awareness in general but also, in particular, engages the triage nurse to look more critically at how they make their own decisions in their everyday practice. PMID:23685041

  12. Vision 20/20: Automation and advanced computing in clinical radiation oncology

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Kevin L., E-mail: kevinmoore@ucsd.edu; Moiseenko, Vitali [Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California 92093 (United States); Kagadis, George C. [Department of Medical Physics, School of Medicine, University of Patras, Rion, GR 26504 (Greece); McNutt, Todd R. [Department of Radiation Oncology and Molecular Radiation Science, School of Medicine, Johns Hopkins University, Baltimore, Maryland 21231 (United States); Mutic, Sasa [Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri 63110 (United States)

    2014-01-15

    This Vision 20/20 paper considers what computational advances are likely to be implemented in clinical radiation oncology in the coming years and how the adoption of these changes might alter the practice of radiotherapy. Four main areas of likely advancement are explored: cloud computing, aggregate data analyses, parallel computation, and automation. As these developments promise both new opportunities and new risks to clinicians and patients alike, the potential benefits are weighed against the hazards associated with each advance, with special considerations regarding patient safety under new computational platforms and methodologies. While the concerns of patient safety are legitimate, the authors contend that progress toward next-generation clinical informatics systems will bring about extremely valuable developments in quality improvement initiatives, clinical efficiency, outcomes analyses, data sharing, and adaptive radiotherapy.

  13. Vision 20/20: Automation and advanced computing in clinical radiation oncology

    International Nuclear Information System (INIS)

    This Vision 20/20 paper considers what computational advances are likely to be implemented in clinical radiation oncology in the coming years and how the adoption of these changes might alter the practice of radiotherapy. Four main areas of likely advancement are explored: cloud computing, aggregate data analyses, parallel computation, and automation. As these developments promise both new opportunities and new risks to clinicians and patients alike, the potential benefits are weighed against the hazards associated with each advance, with special considerations regarding patient safety under new computational platforms and methodologies. While the concerns of patient safety are legitimate, the authors contend that progress toward next-generation clinical informatics systems will bring about extremely valuable developments in quality improvement initiatives, clinical efficiency, outcomes analyses, data sharing, and adaptive radiotherapy

  14. Application of the Stockholm Hierarchy to Defining the Quality of Reference Intervals and Clinical Decision Limits

    OpenAIRE

    Sikaris, Ken

    2012-01-01

    The Stockholm Hierarchy is a professional consensus created to define the preferred approaches to defining analytical quality. The quality of a laboratory measurement can also be classified by the quality of the limits that the value is compared with, namely reference interval limits and clinical decision limits. At the highest level in the hierarchy would be placed clinical decision limits based on clinical outcome studies. The second level would include both formal reference interval studie...

  15. Bayesian Decision Theory and its Applications in Early Phase Clinical Trails

    Institute of Scientific and Technical Information of China (English)

    ZHOU Ying-hui

    2004-01-01

    Bayes'theorem is named after the Reverend Thomas Bayes who proposed the idea in the 18th century[1].It has been adapted by scientists for many different applications.One of the applications is clinical trials,where decisions are guided by clinical expertise as well as by data,especially in early phases.This paper reviews Bayes' theorem,decision theory and their applications in clinical trials.

  16. Measuring the Impact of Diagnostic Decision Support on the Quality of Clinical Decision Making: Development of a Reliable and Valid Composite Score

    OpenAIRE

    Ramnarayan, Padmanabhan; Kapoor, Ritika R; Coren, Michael; Nanduri, Vasantha; Tomlinson, Amanda L.; Taylor, Paul M.; Wyatt, Jeremy C; Britto, Joseph F.

    2003-01-01

    Objective: Few previous studies evaluating the benefits of diagnostic decision support systems have simultaneously measured changes in diagnostic quality and clinical management prompted by use of the system. This report describes a reliable and valid scoring technique to measure the quality of clinical decision plans in an acute medical setting, where diagnostic decision support tools might prove most useful.

  17. The Reliability of a Novel Automated System for ANA Immunofluorescence Analysis in Daily Clinical Practice

    Directory of Open Access Journals (Sweden)

    Mohammed Alsuwaidi

    2016-01-01

    Full Text Available Automated interpretation (AI systems for antinuclear antibody (ANA analysis have been introduced based on assessment of indirect immunofluorescence (IIF patterns. The diagnostic performance of a novel automated IIF reading system was compared with visual interpretation (VI of IIF in daily clinical practice to evaluate the reduction of workload. ANA-IIF tests of consecutive serum samples from patients with suspected connective tissue disease were carried out using HEp-2 cells according to routine clinical care. AI was performed using a visual analyser (Zenit G-Sight, Menarini, Germany. Agreement rates between ANA results by AI and VI were calculated. Of the 336 samples investigated, VI yielded 205 (61% negative, 42 (13% ambiguous, and 89 (26% positive results, whereas 82 (24% were determined to be negative, 176 (52% ambiguous, and 78 (24% positive by AI. AI displayed a diagnostic accuracy of 175/336 samples (52% with a kappa coefficient of 0.34 compared to VI being the gold standard. Solely relying on AI, with VI only performed for all ambiguous samples by AI, would have missed 1 of 89 (1% positive results by VI and misclassified 2 of 205 (1% negative results by VI as positive. The use of AI in daily clinical practice resulted only in a moderate reduction of the VI workload (82 of 336 samples: 24%.

  18. Automated radiosynthesis of [{sup 11}C]morphine for clinical investigation

    Energy Technology Data Exchange (ETDEWEB)

    Fan Jinda [Department of Radiology, Washington University School of Medicine, 510 South Kingshighway Blvd. St. Louis, MO 63110 (United States); Meissner, Konrad [Department of Anesthesiology, Washington University School of Medicine, 510 South Kingshighway Blvd. St. Louis, MO 63110 (United States); Gaehle, Gregory G.; Li Shihong [Department of Radiology, Washington University School of Medicine, 510 South Kingshighway Blvd. St. Louis, MO 63110 (United States); Kharasch, Evan D. [Department of Anesthesiology, Washington University School of Medicine, 510 South Kingshighway Blvd. St. Louis, MO 63110 (United States); Mach, Robert H. [Department of Radiology, Washington University School of Medicine, 510 South Kingshighway Blvd. St. Louis, MO 63110 (United States); Tu Zhude, E-mail: tuz@mir.wustl.ed [Department of Radiology, Washington University School of Medicine, 510 South Kingshighway Blvd. St. Louis, MO 63110 (United States)

    2011-02-15

    To meet a multiple-dose clinical evaluation of the P-gp modulation of [{sup 11}C]morphine delivery into the human brain, radiosynthesis of [{sup 11}C]morphine was accomplished on an automated system by N-methylation of normorphine with [{sup 11}C]CH{sub 3}I. A methodology employing optimized solid phase extraction of the HPLC eluent was developed. Radiosynthesis took 45 min with a radiochemical yield ranging from 45% to 50% and specific activity ranging from 20 to 26 Ci/{mu}mol (decay corrected to end-of-bombardment); radiochemical and chemical purities were >95% (n=28).

  19. Profiling and Automated Decision Making in the Present and New EU Data Protection Frameworks

    DEFF Research Database (Denmark)

    Savin, Andrej

    made possible by a transfer of a staggering portion of our daily lives from the offline world to the Internet. It is a truism that automation would be impossible without our willing participation on the Internet. We freely take part in social networks, post on blogs, and send our emails. On the other...... hand, it is equally true that we are increasingly monitored by the state, by profit‐maximizing corporations and by our fellow citizens and that these methods of monitoring are becoming smarter. Vast amounts of data which have become available and which we contribute, form what we today call “big data...

  20. Conventional Versus Automated Implantation of Loose Seeds in Prostate Brachytherapy: Analysis of Dosimetric and Clinical Results

    Energy Technology Data Exchange (ETDEWEB)

    Genebes, Caroline, E-mail: genebes.caroline@claudiusregaud.fr [Radiation Oncology Department, Institut Claudius Regaud, Toulouse (France); Filleron, Thomas; Graff, Pierre [Radiation Oncology Department, Institut Claudius Regaud, Toulouse (France); Jonca, Frédéric [Department of Urology, Clinique Ambroise Paré, Toulouse (France); Huyghe, Eric; Thoulouzan, Matthieu; Soulie, Michel; Malavaud, Bernard [Department of Urology and Andrology, CHU Rangueil, Toulouse (France); Aziza, Richard; Brun, Thomas; Delannes, Martine; Bachaud, Jean-Marc [Radiation Oncology Department, Institut Claudius Regaud, Toulouse (France)

    2013-11-15

    Purpose: To review the clinical outcome of I-125 permanent prostate brachytherapy (PPB) for low-risk and intermediate-risk prostate cancer and to compare 2 techniques of loose-seed implantation. Methods and Materials: 574 consecutive patients underwent I-125 PPB for low-risk and intermediate-risk prostate cancer between 2000 and 2008. Two successive techniques were used: conventional implantation from 2000 to 2004 and automated implantation (Nucletron, FIRST system) from 2004 to 2008. Dosimetric and biochemical recurrence-free (bNED) survival results were reported and compared for the 2 techniques. Univariate and multivariate analysis researched independent predictors for bNED survival. Results: 419 (73%) and 155 (27%) patients with low-risk and intermediate-risk disease, respectively, were treated (median follow-up time, 69.3 months). The 60-month bNED survival rates were 95.2% and 85.7%, respectively, for patients with low-risk and intermediate-risk disease (P=.04). In univariate analysis, patients treated with automated implantation had worse bNED survival rates than did those treated with conventional implantation (P<.0001). By day 30, patients treated with automated implantation showed lower values of dose delivered to 90% of prostate volume (D90) and volume of prostate receiving 100% of prescribed dose (V100). In multivariate analysis, implantation technique, Gleason score, and V100 on day 30 were independent predictors of recurrence-free status. Grade 3 urethritis and urinary incontinence were observed in 2.6% and 1.6% of the cohort, respectively, with no significant differences between the 2 techniques. No grade 3 proctitis was observed. Conclusion: Satisfactory 60-month bNED survival rates (93.1%) and acceptable toxicity (grade 3 urethritis <3%) were achieved by loose-seed implantation. Automated implantation was associated with worse dosimetric and bNED survival outcomes.

  1. An application of multiattribute decision analysis to the Space Station Freedom program. Case study: Automation and robotics technology evaluation

    Science.gov (United States)

    Smith, Jeffrey H.; Levin, Richard R.; Carpenter, Elisabeth J.

    1990-01-01

    The results are described of an application of multiattribute analysis to the evaluation of high leverage prototyping technologies in the automation and robotics (A and R) areas that might contribute to the Space Station (SS) Freedom baseline design. An implication is that high leverage prototyping is beneficial to the SS Freedom Program as a means for transferring technology from the advanced development program to the baseline program. The process also highlights the tradeoffs to be made between subsidizing high value, low risk technology development versus high value, high risk technology developments. Twenty one A and R Technology tasks spanning a diverse array of technical concepts were evaluated using multiattribute decision analysis. Because of large uncertainties associated with characterizing the technologies, the methodology was modified to incorporate uncertainty. Eight attributes affected the rankings: initial cost, operation cost, crew productivity, safety, resource requirements, growth potential, and spinoff potential. The four attributes of initial cost, operations cost, crew productivity, and safety affected the rankings the most.

  2. STATISTICAL MODELS DECISION SUPPORT FOR INFORMATION SECURITY MANAGEMENT IN AN AUTOMATED SYSTEM

    Directory of Open Access Journals (Sweden)

    Stepanov V. V.

    2015-09-01

    Full Text Available The article deals with mathematical models of management decision-making to select the option to protect the AU, based on sufficient statistical information about attacks on the AU. The amount of a priori uncertainty about the choice of protection option in GIS was described with Boltzmann's entropy. Introduction of the value within Shannon’s definition of mutual information is called the context random variables, it allows removing the uncertainty regarding the actions of the enemy, and it enables decisionmakers to choose protection options. The model of decision for choosing the type of protection of the AIS presented in the article is based on sufficient statistical information about the attacks to the system components. In the ideal case, for decision-making, we use large sample statistical data that provides high accuracy control system for protection of information. Based on the available amount of information available to the IPA, against the acts of SIN, it is possible to choose a decision on the choices you make

  3. Impact of the introduction of an automated microbiologic system on the clinical outcomes of bloodstream infections caused by Enterobacteriaceae strains

    OpenAIRE

    Luciana Azevedo Callefi; Eduardo Alexandrino Servolo Medeiros; Guilherme Henrique Campos Furtado

    2013-01-01

    INTRODUCTION: Enterobacteriaceae strains are a leading cause of bloodstream infections (BSI). The aim of this study is to assess differences in clinical outcomes of patients with BSI caused by Enterobacteriaceae strains before and after introduction of an automated microbiologic system by the microbiology laboratory. METHODS: We conducted a retrospective cohort study aimed to evaluate the impact of the introduction of an automated microbiologic system (Phoenix(tm)...

  4. Automated astatination of biomolecules - a stepping stone towards multicenter clinical trials

    Science.gov (United States)

    Aneheim, Emma; Albertsson, Per; Bäck, Tom; Jensen, Holger; Palm, Stig; Lindegren, Sture

    2015-07-01

    To facilitate multicentre clinical studies on targeted alpha therapy, it is necessary to develop an automated, on-site procedure for conjugating rare, short-lived, alpha-emitting radionuclides to biomolecules. Astatine-211 is one of the few alpha-emitting nuclides with appropriate chemical and physical properties for use in targeted therapies for cancer. Due to the very short range of the emitted α-particles, this therapy is particularly suited to treating occult, disseminated cancers. Astatine is not intrinsically tumour-specific; therefore, it requires an appropriate tumour-specific targeting vector, which can guide the radiation to the cancer cells. Consequently, an appropriate method is required for coupling the nuclide to the vector. To increase the availability of astatine-211 radiopharmaceuticals for targeted alpha therapy, their production should be automated. Here, we present a method that combines dry distillation of astatine-211 and a synthesis module for producing radiopharmaceuticals into a process platform. This platform will standardize production of astatinated radiopharmaceuticals, and hence, it will facilitate large clinical studies focused on this promising, but chemically challenging, alpha-emitting radionuclide. In this work, we describe the process platform, and we demonstrate the production of both astaine-211, for preclinical use, and astatine-211 labelled antibodies.

  5. Mental Workload as a Key Factor in Clinical Decision Making

    Science.gov (United States)

    Byrne, Aidan

    2013-01-01

    The decision making process is central to the practice of a clinician and has traditionally been described in terms of the hypothetico-deductive model. More recently, models adapted from cognitive psychology, such as the dual process and script theories have proved useful in explaining patterns of practice not consistent with purely cognitive…

  6. [Locator or ball attachment: a guide for clinical decision making].

    Science.gov (United States)

    Büttel, Adrian E; Bühler, Nico M; Marinello, Carlo P

    2009-01-01

    Various attachments are available to retain overdentures on natural roots or implants. Technical aspects, the clinical handling, the capability to adapt or repair and the costs are parameters to be considered when choosing the appropriate attachment. Ball attachments and bars are clinically established and well documented. Ball attachments as prefabricated, unsplinted units are easily replaceable and show hygienic advantages, while bars show favorable stability. The Locator is a newer, popular clinical alternative to these established attachments. The ball attachment and the Locator are compared from a technical and clinical point of view. PMID:19852208

  7. STATISTICAL MODELS DECISION SUPPORT FOR INFORMATION SECURITY MANAGEMENT IN AN AUTOMATED SYSTEM

    OpenAIRE

    Stepanov V. V.; Kucher V. A.

    2015-01-01

    The article deals with mathematical models of management decision-making to select the option to protect the AU, based on sufficient statistical information about attacks on the AU. The amount of a priori uncertainty about the choice of protection option in GIS was described with Boltzmann's entropy. Introduction of the value within Shannon’s definition of mutual information is called the context random variables, it allows removing the uncertainty regarding the actions of the enemy, and it e...

  8. Disciplined Decision Making in an Interdisciplinary Environment: Some Implications for Clinical Applications of Statistical Process Control.

    Science.gov (United States)

    Hantula, Donald A.

    1995-01-01

    Clinical applications of statistical process control (SPC) in human service organizations are considered. SPC is seen as providing a standard set of criteria that serves as a common interface for data-based decision making, which may bring decision making under the control of established contingencies rather than the immediate contingencies of…

  9. Factors Predicting Oncology Care Providers' Behavioral Intention to Adopt Clinical Decision Support Systems

    Science.gov (United States)

    Wolfenden, Andrew

    2012-01-01

    The purpose of this quantitative correlation study was to examine the predictors of user behavioral intention on the decision of oncology care providers to adopt or reject the clinical decision support system. The Unified Theory of Acceptance and Use of Technology (UTAUT) formed the foundation of the research model and survey instrument. The…

  10. Do clinical prediction models improve concordance of treatment decisions in reproductive medicine?

    NARCIS (Netherlands)

    J.W. van der Steeg; P. Steures; M.J.C. Eijkemans; J.D.F. Habbema; P.M.M. Bossuyt; P.G.A. Hompes; F. van der Veen; B.W.J. Mol

    2006-01-01

    Objective To assess whether the use of clinical prediction models improves concordance between gynaecologists with respect to treatment decisions in reproductive medicine. Design We constructed 16 vignettes of subfertile couples by varying fertility history, postcoital test, sperm motility, follicle

  11. Clinical Decision Analysis and Markov Modeling for Surgeons: An Introductory Overview.

    Science.gov (United States)

    Hogendoorn, Wouter; Moll, Frans L; Sumpio, Bauer E; Hunink, M G Myriam

    2016-08-01

    This study addresses the use of decision analysis and Markov models to make contemplated decisions for surgical problems. Decision analysis and decision modeling in surgical research are increasing, but many surgeons are unfamiliar with the techniques and are skeptical of the results. The goal of this review is to familiarize surgeons with techniques and terminology used in decision analytic papers, to provide the reader a practical guide to read these papers, and to ensure that surgeons can critically appraise the quality of published clinical decision models and draw well founded conclusions from such reports.First, a brief explanation of decision analysis and Markov models is presented in simple steps, followed by an overview of the components of a decision and Markov model. Subsequently, commonly used terms and definitions are described and explained, including quality-adjusted life-years, disability-adjusted life-years, discounting, half-cycle correction, cycle length, probabilistic sensitivity analysis, incremental cost-effectiveness ratio, and the willingness-to-pay threshold.Finally, the advantages and limitations of research with Markov models are described, and new modeling techniques and future perspectives are discussed. It is important that surgeons are able to understand conclusions from decision analytic studies and are familiar with the specific definitions of the terminology used in the field to keep up with surgical research. Decision analysis can guide treatment strategies when complex clinical questions need to be answered and is a necessary and useful addition to the surgical research armamentarium. PMID:26756750

  12. MACVIA Clinical Decision Algorithm in Allergic Rhinitis in adolescents and adults

    OpenAIRE

    Bousquet, Jean; Schünemann, Holger J.; Hellings, Peter W.; Arnavielhe, Sylvie; Bachert, Claus; Bedbrook, Anna; Bergmann, Karl-Christian; Bosnic-Anticevich, Sinthia; Brozek, Jan; Calderon, Moises; Canonica, G. Walter; Casale, Thomas B.; Chavannes, Niels H; Cox, Linda; Chrystyn, Henry

    2016-01-01

    International audience The selection of pharmacotherapy for patients with allergic rhinitis depends on several factors, including age, prominent symptoms, symptom severity, control of allergic rhinitis, patient preferences and cost. Allergen exposure and resulting symptoms vary and treatment adjustment is required. Clinical decision support systems (CDSS) may be beneficial for the assessment of disease control. Clinical decision support systems should be based on the best evidence and algo...

  13. The effect of concept mapping on clinical decision making skills of ICU nurses

    OpenAIRE

    Fakhri Dokht Akbari; Malahat Nikravan Mofrad; Azam Dabirian

    2014-01-01

    Introduction: Concept mapping is an innovative tool that would help hospital educators and nurses to promote their knowledge and clinical decision making skills. The aim of this study was to investigate the effect of concept mapping on clinical decision making skills of nurses working in the intensive care unit (ICU). Methods: The quasi-experimental, non-equivalent control group, pretest-posttest design was conducted among baccalaureate nurses working in an intensive care unit. Forty two nur...

  14. Clinical decision support must be useful, functional is not enough

    DEFF Research Database (Denmark)

    Kortteisto, Tiina; Komulainen, Jorma; Mäkelä, Marjukka;

    2012-01-01

    ABSTRACT: BACKGROUND: Health information technology, particularly electronic decision support systems, can reduce the existing gap between evidence-based knowledge and health care practice but professionals have to accept and use this information. Evidence is scant on which features influence the...... professionals receiving patient-specific guidance at the point of care. Multiple data (focus groups, questionnaire and spontaneous feedback) were analyzed using deductive content analysis and descriptive statistics. RESULTS: The content of the guidance is a significant feature of the primary care professional......'s intention to use eCDS. The decisive reason for using or not using the eCDS is its perceived usefulness. Functional characteristics such as speed and ease of use are important but alone these are not enough. Specific information technology, professional, patient and environment features can help or hinder...

  15. A controlled trial of automated classification of negation from clinical notes

    Directory of Open Access Journals (Sweden)

    Carruth William

    2005-05-01

    Full Text Available Abstract Background Identification of negation in electronic health records is essential if we are to understand the computable meaning of the records: Our objective is to compare the accuracy of an automated mechanism for assignment of Negation to clinical concepts within a compositional expression with Human Assigned Negation. Also to perform a failure analysis to identify the causes of poorly identified negation (i.e. Missed Conceptual Representation, Inaccurate Conceptual Representation, Missed Negation, Inaccurate identification of Negation. Methods 41 Clinical Documents (Medical Evaluations; sometimes outside of Mayo these are referred to as History and Physical Examinations were parsed using the Mayo Vocabulary Server Parsing Engine. SNOMED-CT™ was used to provide concept coverage for the clinical concepts in the record. These records resulted in identification of Concepts and textual clues to Negation. These records were reviewed by an independent medical terminologist, and the results were tallied in a spreadsheet. Where questions on the review arose Internal Medicine Faculty were employed to make a final determination. Results SNOMED-CT was used to provide concept coverage of the 14,792 Concepts in 41 Health Records from John's Hopkins University. Of these, 1,823 Concepts were identified as negative by Human review. The sensitivity (Recall of the assignment of negation was 97.2% (p Conclusion Automated assignment of negation to concepts identified in health records based on review of the text is feasible and practical. Lexical assignment of negation is a good test of true Negativity as judged by the high sensitivity, specificity and positive likelihood ratio of the test. SNOMED-CT had overall coverage of 88.7% of the concepts being negated.

  16. Information management to enable personalized medicine: stakeholder roles in building clinical decision support

    Directory of Open Access Journals (Sweden)

    Brinner Kristin M

    2009-10-01

    Full Text Available Abstract Background Advances in technology and the scientific understanding of disease processes are presenting new opportunities to improve health through individualized approaches to patient management referred to as personalized medicine. Future health care strategies that deploy genomic technologies and molecular therapies will bring opportunities to prevent, predict, and pre-empt disease processes but will be dependent on knowledge management capabilities for health care providers that are not currently available. A key cornerstone to the potential application of this knowledge will be effective use of electronic health records. In particular, appropriate clinical use of genomic test results and molecularly-targeted therapies present important challenges in patient management that can be effectively addressed using electronic clinical decision support technologies. Discussion Approaches to shaping future health information needs for personalized medicine were undertaken by a work group of the American Health Information Community. A needs assessment for clinical decision support in electronic health record systems to support personalized medical practices was conducted to guide health future development activities. Further, a suggested action plan was developed for government, researchers and research institutions, developers of electronic information tools (including clinical guidelines, and quality measures, and standards development organizations to meet the needs for personalized approaches to medical practice. In this article, we focus these activities on stakeholder organizations as an operational framework to help identify and coordinate needs and opportunities for clinical decision support tools to enable personalized medicine. Summary This perspective addresses conceptual approaches that can be undertaken to develop and apply clinical decision support in electronic health record systems to achieve personalized medical care. In

  17. Quantifying explainable discrimination and removing illegal discrimination in automated decision making

    KAUST Repository

    Kamiran, Faisal

    2012-11-18

    Recently, the following discrimination-aware classification problem was introduced. Historical data used for supervised learning may contain discrimination, for instance, with respect to gender. The question addressed by discrimination-aware techniques is, given sensitive attribute, how to train discrimination-free classifiers on such historical data that are discriminative, with respect to the given sensitive attribute. Existing techniques that deal with this problem aim at removing all discrimination and do not take into account that part of the discrimination may be explainable by other attributes. For example, in a job application, the education level of a job candidate could be such an explainable attribute. If the data contain many highly educated male candidates and only few highly educated women, a difference in acceptance rates between woman and man does not necessarily reflect gender discrimination, as it could be explained by the different levels of education. Even though selecting on education level would result in more males being accepted, a difference with respect to such a criterion would not be considered to be undesirable, nor illegal. Current state-of-the-art techniques, however, do not take such gender-neutral explanations into account and tend to overreact and actually start reverse discriminating, as we will show in this paper. Therefore, we introduce and analyze the refined notion of conditional non-discrimination in classifier design. We show that some of the differences in decisions across the sensitive groups can be explainable and are hence tolerable. Therefore, we develop methodology for quantifying the explainable discrimination and algorithmic techniques for removing the illegal discrimination when one or more attributes are considered as explanatory. Experimental evaluation on synthetic and real-world classification datasets demonstrates that the new techniques are superior to the old ones in this new context, as they succeed in

  18. Visual cluster analysis in support of clinical decision intelligence.

    Science.gov (United States)

    Gotz, David; Sun, Jimeng; Cao, Nan; Ebadollahi, Shahram

    2011-01-01

    Electronic health records (EHRs) contain a wealth of information about patients. In addition to providing efficient and accurate records for individual patients, large databases of EHRs contain valuable information about overall patient populations. While statistical insights describing an overall population are beneficial, they are often not specific enough to use as the basis for individualized patient-centric decisions. To address this challenge, we describe an approach based on patient similarity which analyzes an EHR database to extract a cohort of patient records most similar to a specific target patient. Clusters of similar patients are then visualized to allow interactive visual refinement by human experts. Statistics are then extracted from the refined patient clusters and displayed to users. The statistical insights taken from these refined clusters provide personalized guidance for complex decisions. This paper focuses on the cluster refinement stage where an expert user must interactively (a) judge the quality and contents of automatically generated similar patient clusters, and (b) refine the clusters based on his/her expertise. We describe the DICON visualization tool which allows users to interactively view and refine multidimensional similar patient clusters. We also present results from a preliminary evaluation where two medical doctors provided feedback on our approach. PMID:22195102

  19. LERM (Logical Elements Rule Method): A method for assessing and formalizing clinical rules for decision support

    NARCIS (Netherlands)

    S. Medlock; D. Opondo; S. Eslami; M. Askari; P. Wierenga; S.E. de Rooij; A. Abu-Hanna

    2011-01-01

    Purpose: The aim of this study was to create a step-by-step method for transforming clinical rules for use in decision support, and to validate this method for usability and reliability. Methods: A sample set of clinical rules was identified from the relevant literature. Using an iterative approach

  20. Clinical decision-making and therapeutic approaches in osteopathy - a qualitative grounded theory study.

    Science.gov (United States)

    Thomson, Oliver P; Petty, Nicola J; Moore, Ann P

    2014-02-01

    There is limited understanding of how osteopaths make decisions in relation to clinical practice. The aim of this research was to construct an explanatory theory of the clinical decision-making and therapeutic approaches of experienced osteopaths in the UK. Twelve UK registered osteopaths participated in this constructivist grounded theory qualitative study. Purposive and theoretical sampling was used to select participants. Data was collected using semi-structured interviews which were audio-recorded and transcribed. As the study approached theoretical sufficiency, participants were observed and video-recorded during a patient appointment, which was followed by a video-prompted interview. Constant comparative analysis was used to analyse and code data. Data analysis resulted in the construction of three qualitatively different therapeutic approaches which characterised participants and their clinical practice, termed; Treater, Communicator and Educator. Participants' therapeutic approach influenced their approach to clinical decision-making, the level of patient involvement, their interaction with patients, and therapeutic goals. Participants' overall conception of practice lay on a continuum ranging from technical rationality to professional artistry, and contributed to their therapeutic approach. A range of factors were identified which influenced participants' conception of practice. The findings indicate that there is variation in osteopaths' therapeutic approaches to practice and clinical decision-making, which are influenced by their overall conception of practice. This study provides the first explanatory theory of the clinical decision-making and therapeutic approaches of osteopaths. PMID:23932101

  1. Detecting fast, online reasoning processes in clinical decision making.

    Science.gov (United States)

    Flores, Amanda; Cobos, Pedro L; López, Francisco J; Godoy, Antonio

    2014-06-01

    In an experiment that used the inconsistency paradigm, experienced clinical psychologists and psychology students performed a reading task using clinical reports and a diagnostic judgment task. The clinical reports provided information about the symptoms of hypothetical clients who had been previously diagnosed with a specific mental disorder. Reading times of inconsistent target sentences were slower than those of control sentences, demonstrating an inconsistency effect. The results also showed that experienced clinicians gave different weights to different symptoms according to their relevance when fluently reading the clinical reports provided, despite the fact that all the symptoms were of equal diagnostic value according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000). The diagnostic judgment task yielded a similar pattern of results. In contrast to previous findings, the results of the reading task may be taken as direct evidence of the intervention of reasoning processes that occur very early, rapidly, and online. We suggest that these processes are based on the representation of mental disorders and that these representations are particularly suited to fast retrieval from memory and to making inferences. They may also be related to the clinicians' causal reasoning. The implications of these results for clinician training are also discussed. PMID:24274045

  2. Can computerized clinical decision support systems improve practitioners' diagnostic test ordering behavior? A decision-maker-researcher partnership systematic review

    Directory of Open Access Journals (Sweden)

    Weise-Kelly Lorraine

    2011-08-01

    Full Text Available Abstract Background Underuse and overuse of diagnostic tests have important implications for health outcomes and costs. Decision support technology purports to optimize the use of diagnostic tests in clinical practice. The objective of this review was to assess whether computerized clinical decision support systems (CCDSSs are effective at improving ordering of tests for diagnosis, monitoring of disease, or monitoring of treatment. The outcome of interest was effect on the diagnostic test-ordering behavior of practitioners. Methods We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews database, Inspec, and reference lists for eligible articles published up to January 2010. We included randomized controlled trials comparing the use of CCDSSs to usual practice or non-CCDSS controls in clinical care settings. Trials were eligible if at least one component of the CCDSS gave suggestions for ordering or performing a diagnostic procedure. We considered studies 'positive' if they showed a statistically significant improvement in at least 50% of test ordering outcomes. Results Thirty-five studies were identified, with significantly higher methodological quality in those published after the year 2000 (p = 0.002. Thirty-three trials reported evaluable data on diagnostic test ordering, and 55% (18/33 of CCDSSs improved testing behavior overall, including 83% (5/6 for diagnosis, 63% (5/8 for treatment monitoring, 35% (6/17 for disease monitoring, and 100% (3/3 for other purposes. Four of the systems explicitly attempted to reduce test ordering rates and all succeeded. Factors of particular interest to decision makers include costs, user satisfaction, and impact on workflow but were rarely investigated or reported. Conclusions Some CCDSSs can modify practitioner test-ordering behavior. To better inform development and implementation efforts, studies should describe in more detail potentially

  3. Integration of Automated Decision Support Systems with Data Mining Abstract: A Client Perspective

    Directory of Open Access Journals (Sweden)

    Abdullah Saad AL-Malaise

    2013-03-01

    Full Text Available Customer’s behavior and satisfaction are always play important role to increase organization’s growth and market value. Customers are on top priority for the growing organization to build up their businesses. In this paper presents the architecture of Decision Support Systems (DSS in connection to deal with the customer’s enquiries and requests. Main purpose behind the proposed model is to enhance the customer’s satisfaction and behavior using DSS. We proposed model by extension in traditional DSS concepts with integration of Data Mining (DM abstract. The model presented in this paper shows the comprehensive architecture to work on the customer requests using DSS and knowledge management (KM for improving the customer’s behavior and satisfaction. Furthermore, DM abstract provides more methods and techniques; to understand the contacted customer’s data, to classify the replied answers in number of classes, and to generate association between the same type of queries, and finally to maintain the KM for future correspondence.

  4. Feasibility of incorporating genomic knowledge into electronic medical records for pharmacogenomic clinical decision support

    Directory of Open Access Journals (Sweden)

    Hoath James I

    2010-10-01

    Full Text Available Abstract In pursuing personalized medicine, pharmacogenomic (PGx knowledge may help guide prescribing drugs based on a person’s genotype. Here we evaluate the feasibility of incorporating PGx knowledge, combined with clinical data, to support clinical decision-making by: 1 analyzing clinically relevant knowledge contained in PGx knowledge resources; 2 evaluating the feasibility of a rule-based framework to support formal representation of clinically relevant knowledge contained in PGx knowledge resources; and, 3 evaluating the ability of an electronic medical record/electronic health record (EMR/EHR to provide computable forms of clinical data needed for PGx clinical decision support. Findings suggest that the PharmGKB is a good source for PGx knowledge to supplement information contained in FDA approved drug labels. Furthermore, we found that with supporting knowledge (e.g. IF age

  5. Adolescent Depression: An Update and Guide to Clinical Decision Making

    OpenAIRE

    Cook, Mary N.; Peterson, John; Sheldon, Christopher

    2009-01-01

    Depression in adolescence and adulthood is common, afflicting up to 20 percent of these populations. It represents a significant public health concern and is associated with considerable suffering and functional impairment. Adolescent-onset depression tends to be a particularly malignant and recalcitrant condition, increasing the likelihood of recurrence and chronicity in adulthood. Clinical presentations for various medical and psychiatric conditions, as well as reactions to psychosocial str...

  6. Clinical implementation of RNA signatures for pharmacogenomic decision-making

    OpenAIRE

    Tang W; Hu Z.; Muallem H; Gulley ML

    2011-01-01

    Weihua Tang1, Zhiyuan Hu2, Hind Muallem1, Margaret L Gulley1,21Department of Pathology and Laboratory Medicine, 2Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, NC, USAAbstract: RNA profiling is increasingly used to predict drug response, dose, or toxicity based on analysis of drug pharmacokinetic or pharmacodynamic pathways. Before implementing multiplexed RNA arrays in clinical practice, validation studies are carried out to demonstrate s...

  7. Clinical evaluation of 64-slice CT assessment of global left ventricular function using automated cardiac phase selection

    International Nuclear Information System (INIS)

    Left ventricular (LV) function provides prognostic information regarding the morbidity and mortality of patients. An automated cardiac phase selection algorithm has the potential to support the assessment of LV function with computed tomography (CT). This algorithm is clinically evaluated for 64-slice cardiac CT. Examinations of twenty consecutive patients were selected. Electrocardiogram gated contrast-enhanced CT was performed. Reconstructions were performed using an automated and a manual method, followed by the determination of the global LV function. Significances were tested using 2-sided Student's t-tests. Reduction in post processing time and storage capacity were estimated. A slightly smaller mean end-systolic volume was found with the automated method (52±18 ml vs 54±17 ml, p=0.02, r=0.99). The mean LV ejection fraction was slightly larger with the automated method (65±8% vs 64±8%, p=0.004, r=0.99). The estimated reduction in post processing time was maximal 5 min per patient with a potential 80% data storage reduction. Results of the automated phase selection algorithm are similar to the manual method. The automated tool reduces post processing time, reconstruction time and transfer time. (author)

  8. Decision analysis in clinical radiology by means of Markov modeling

    International Nuclear Information System (INIS)

    Markov models (Multistate transition models) are mathematical tools to simulate a cohort of individuals followed over time to assess the prognosis resulting from different strategies. They are applied on the assumption that persons are in one of a finite number of states of health (Markov states). Each condition is given a transition probability as well as an incremental value. Probabilities may be chosen constant or varying over time due to predefined rules. Time horizon is divided into equal increments (Markov cycles). The model calculates quality-adjusted life expectancy employing real-life units and values and summing up the length of time spent in each health state adjusted for objective outcomes and subjective appraisal. This sort of modeling prognosis for a given patient is analogous to utility in common decision trees. Markov models can be evaluated by matrix algebra, probabilistic cohort simulation and Monte Carlo simulation. They have been applied to assess the relative benefits and risks of a limited number of diagnostic and therapeutic procedures in radiology. More interventions should be submitted to Markov analyses in order to elucidate their cost-effectiveness. (orig.)

  9. Clinical decision making in seizures and status epilepticus.

    Science.gov (United States)

    Teran, Felipe; Harper-Kirksey, Katrina; Jagoda, Andy

    2015-01-01

    Seizures and status epilepticus are frequent neurologic emergencies in the emergency department, accounting for 1% of all emergency department visits. The management of this time-sensitive and potentially life-threatening condition is challenging for both prehospital providers and emergency clinicians. The approach to seizing patients begins with differentiating seizure activity from mimics and follows with identifying potential secondary etiologies, such as alcohol-related seizures. The approach to the patient in status epilepticus and the patient with nonconvulsive status epilepticus constitutes a special clinical challenge. This review summarizes the best available evidence and recommendations regarding diagnosis and resuscitation of the seizing patient in the emergency setting. PMID:25902572

  10. Effect of Automated Online Counseling on Clinical Outcomes and Quality of Life Among Adolescents With Acne Vulgaris

    Science.gov (United States)

    Tuong, William; Wang, Audrey S.; Armstrong, April W.

    2016-01-01

    IMPORTANCE Effective patient education is necessary for treating patients with acne vulgaris. Automated online counseling simulates face-to-face encounters and may be a useful tool to deliver education. OBJECTIVE To compare the effectiveness of a standard educational website with that of an automated-counseling website in improving clinical outcomes and quality of life among adolescents with acne. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted between March 27, 2014, and June 27, 2014, including a 12-week follow-up in a local inner-city high school. Ninety-eight students aged at least 13 years with mild to moderate acne were eligible for participation. A per-protocol analysis of the evaluable population was conducted on clinical outcome data. INTERVENTIONS Participants viewed either a standard educational website or an automated-counseling website. MAIN OUTCOMES AND MEASURES The primary outcome was the total acne lesion count. Secondary measures included the Children’s Dermatology Life Quality Index (CDLQI) scores and general skin care behavior. RESULTS Forty-nine participants were randomized to each group. At baseline, the mean (SD) total acne lesion count was not significantly different between the standard-website group and the automated-counseling–website group (21.33 [10.81] vs 25.33 [12.45]; P = .10). Improvement in the mean (SD) acne lesion count was not significantly different between the standard-website group and the automated-counseling–website group (0.20 [9.26] vs 3.90 [12.19]; P = .10). The mean (SD) improvement in CDLQI score for the standard-website group was not significantly different from that of the automated-counseling–website group (0.17 [2.64] vs 0.39 [2.94]; P = .71). After 12 weeks, a greater proportion of participants in the automated-counseling–website group maintained or adopted a recommended anti-acne skin care routine compared with the standard-website group (43% vs 22%; P = .03). CONCLUSIONS AND

  11. Clinical application of the UMLS in a computerized order entry and decision-support system.

    OpenAIRE

    Geissbuhler, A.; Miller, R A

    1998-01-01

    Vanderbilt University Medical Center uses the UMLS as a dictionary, an interlingua, and a knowledge source within the WizOrder system. WizOrder provides direct care-provider order entry and integrated clinical decision-support capabilities. Linking the two functions enables efficient decision-support during the "normal" workflow of care providers, at the point where decisions are made. WizOrder uses the UMLS as a dictionary to encode free-text entries into controlled vocabularies such as ICD9...

  12. Quantitative ultrasound texture analysis for clinical decision making support

    Science.gov (United States)

    Wu, Jie Ying; Beland, Michael; Konrad, Joseph; Tuomi, Adam; Glidden, David; Grand, David; Merck, Derek

    2015-03-01

    We propose a general ultrasound (US) texture-analysis and machine-learning framework for detecting the presence of disease that is suitable for clinical application across clinicians, disease types, devices, and operators. Its stages are image selection, image filtering, ROI selection, feature parameterization, and classification. Each stage is modular and can be replaced with alternate methods. Thus, this framework is adaptable to a wide range of tasks. Our two preliminary clinical targets are hepatic steatosis and adenomyosis diagnosis. For steatosis, we collected US images from 288 patients and their pathology-determined values of steatosis (%) from biopsies. Two radiologists independently reviewed all images and identified the region of interest (ROI) most representative of the hepatic echotexture for each patient. To parameterize the images into comparable quantities, we filter the US images at multiple scales for various texture responses. For each response, we collect a histogram of pixel features within the ROI, and parameterize it as a Gaussian function using its mean, standard deviation, kurtosis, and skew to create a 36-feature vector. Our algorithm uses a support vector machine (SVM) for classification. Using a threshold of 10%, we achieved 72.81% overall accuracy, 76.18% sensitivity, and 65.96% specificity in identifying steatosis with leave-ten-out cross-validation (padenomyosis, we identified 38 patients with MR-confirmed findings of adenomyosis and previous US studies and 50 controls. A single rater picked the best US-image and ROI for each case. Using the same processing pipeline, we obtained 76.14% accuracy, 86.00% sensitivity, and 63.16% specificity with leave-one-out cross-validation (p<0.0001).

  13. Clinical decision making on the use of physical restraint in intensive care units

    Directory of Open Access Journals (Sweden)

    Xinqian Li

    2014-12-01

    Full Text Available Physical restraint is a common nursing intervention in intensive care units and nurses often use it to ensure patients' safety and to prevent unexpected accidents. However, existing literature indicated that the use of physical restraint is a complex one because of inadequate rationales, the negative physical and emotional effects on patients, but the lack of perceived alternatives. This paper is aimed to interpret the clinical decision-making theories related to the use of physical restraint in intensive care units in order to facilitate our understanding on the use of physical restraint and to evaluate the quality of decisions made by nurses. By reviewing the literature, intuition and heuristics are the main decision-making strategies related to the use of physical restraint in intensive care units because the rapid and reflexive nature of intuition and heuristics allow nurses to have a rapid response to urgent and emergent cases. However, it is problematic if nurses simply count their decision-making on experience rather than incorporate research evidence into clinical practice because of inadequate evidence to support the use of physical restraint. Besides that, such a rapid response may lead nurses to make decisions without adequate assessment and thinking and therefore biases and errors may be generated. Therefore, despite the importance of intuition and heuristics in decision-making in acute settings on the use of physical restraint, it is recommended that nurses should incorporate research evidence with their experience to make decisions and adequate assessment before implementing physical restraint is also necessary.

  14. Drug susceptibility testing of clinical isolates of streptococci and enterococci by the Phoenix automated microbiology system

    Directory of Open Access Journals (Sweden)

    Sokeng Gertrude

    2007-05-01

    Full Text Available Abstract Background Drug resistance is an emerging problem among streptococcal and enterococcal species. Automated diagnostic systems for species identification and antimicrobial susceptibility testing (AST have become recently available. We evaluated drug susceptibility of clinical isolates of streptococci and enterococci using the recent Phoenix system (BD, Sparks, MD. Diagnostic tools included the new SMIC/ID-2 panel for streptococci, and the PMIC/ID-14 for enterococci. Two-hundred and fifty isolates have been investigated: β-hemolytic streptococci (n = 65, Streptococcus pneumoniae (n = 50, viridans group streptococci (n = 32, Enterococcus faecium (n = 40, Enterococcus faecalis (n = 43, other catalase-negative cocci (n = 20. When needed, species ID was determined using molecular methods. Test bacterial strains were chosen among those carrying clinically-relevant resistance determinants (penicillin, macrolides, fluoroquinolones, glycopeptides. AST results of the Phoenix system were compared to minimal inhibitory concentration (MIC values measured by the Etest method (AB Biodisk, Solna, Sweden. Results Streptococci: essential agreement (EA and categorical agreement (CA were 91.9% and 98.8%, respectively. Major (ME and minor errors (mE accounted for 0.1% and 1.1% of isolates, respectively. No very major errors (VME were produced. Enterococci: EA was 97%, CA 96%. Small numbers of VME (0.9%, ME (1.4% and mE (2.8% were obtained. Overall, EA and CA rates for most drugs were above 90% for both genera. A few VME were found: a teicoplanin and high-level streptomycin for E. faecalis, b high-level gentamicin for E. faecium. The mean time to results (± SD was 11.8 ± 0.9 h, with minor differences between streptococci and enterococci. Conclusion The Phoenix system emerged as an effective tool for quantitative AST. Panels based on dilution tests provided rapid and accurate MIC values with regard to clinically-relevant streptococcal and enterococcal

  15. MODULAR ANALYTICS: A New Approach to Automation in the Clinical Laboratory

    Directory of Open Access Journals (Sweden)

    Olivier Golaz

    2005-01-01

    Full Text Available MODULAR ANALYTICS (Roche Diagnostics (MODULAR ANALYTICS, Elecsys and Cobas Integra are trademarks of a member of the Roche Group represents a new approach to automation for the clinical chemistry laboratory. It consists of a control unit, a core unit with a bidirectional multitrack rack transportation system, and three distinct kinds of analytical modules: an ISE module, a P800 module (44 photometric tests, throughput of up to 800 tests/h, and a D2400 module (16 photometric tests, throughput up to 2400 tests/h. MODULAR ANALYTICS allows customised configurations for various laboratory workloads. The performance and practicability of MODULAR ANALYTICS were evaluated in an international multicentre study at 16 sites. Studies included precision, accuracy, analytical range, carry-over, and workflow assessment. More than 700 000 results were obtained during the course of the study. Median between-day CVs were typically less than 3% for clinical chemistries and less than 6% for homogeneous immunoassays. Median recoveries for nearly all standardised reference materials were within 5% of assigned values. Method comparisons versus current existing routine instrumentation were clinically acceptable in all cases. During the workflow studies, the work from three to four single workstations was transferred to MODULAR ANALYTICS, which offered over 100 possible methods, with reduction in sample splitting, handling errors, and turnaround time. Typical sample processing time on MODULAR ANALYTICS was less than 30 minutes, an improvement from the current laboratory systems. By combining multiple analytic units in flexible ways, MODULAR ANALYTICS met diverse laboratory needs and offered improvement in workflow over current laboratory situations. It increased overall efficiency while maintaining (or improving quality.

  16. XeNA: an automated 'open-source' (129)Xe hyperpolarizer for clinical use.

    Science.gov (United States)

    Nikolaou, Panayiotis; Coffey, Aaron M; Walkup, Laura L; Gust, Brogan M; Whiting, Nicholas; Newton, Hayley; Muradyan, Iga; Dabaghyan, Mikayel; Ranta, Kaili; Moroz, Gregory D; Rosen, Matthew S; Patz, Samuel; Barlow, Michael J; Chekmenev, Eduard Y; Goodson, Boyd M

    2014-06-01

    Here we provide a full report on the construction, components, and capabilities of our consortium's "open-source" large-scale (~1L/h) (129)Xe hyperpolarizer for clinical, pre-clinical, and materials NMR/MRI (Nikolaou et al., Proc. Natl. Acad. Sci. USA, 110, 14150 (2013)). The 'hyperpolarizer' is automated and built mostly of off-the-shelf components; moreover, it is designed to be cost-effective and installed in both research laboratories and clinical settings with materials costing less than $125,000. The device runs in the xenon-rich regime (up to 1800Torr Xe in 0.5L) in either stopped-flow or single-batch mode-making cryo-collection of the hyperpolarized gas unnecessary for many applications. In-cell (129)Xe nuclear spin polarization values of ~30%-90% have been measured for Xe loadings of ~300-1600Torr. Typical (129)Xe polarization build-up and T1 relaxation time constants were ~8.5min and ~1.9h respectively under our spin-exchange optical pumping conditions; such ratios, combined with near-unity Rb electron spin polarizations enabled by the high resonant laser power (up to ~200W), permit such high PXe values to be achieved despite the high in-cell Xe densities. Importantly, most of the polarization is maintained during efficient HP gas transfer to other containers, and ultra-long (129)Xe relaxation times (up to nearly 6h) were observed in Tedlar bags following transport to a clinical 3T scanner for MR spectroscopy and imaging as a prelude to in vivo experiments. The device has received FDA IND approval for a clinical study of chronic obstructive pulmonary disease subjects. The primary focus of this paper is on the technical/engineering development of the polarizer, with the explicit goals of facilitating the adaptation of design features and operative modes into other laboratories, and of spurring the further advancement of HP-gas MR applications in biomedicine. PMID:24631715

  17. Computerized clinical decision support systems for chronic disease management: A decision-maker-researcher partnership systematic review

    Directory of Open Access Journals (Sweden)

    Navarro Tamara

    2011-08-01

    Full Text Available Abstract Background The use of computerized clinical decision support systems (CCDSSs may improve chronic disease management, which requires recurrent visits to multiple health professionals, ongoing disease and treatment monitoring, and patient behavior modification. The objective of this review was to determine if CCDSSs improve the processes of chronic care (such as diagnosis, treatment, and monitoring of disease and associated patient outcomes (such as effects on biomarkers and clinical exacerbations. Methods We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews database, Inspec, and reference lists for potentially eligible articles published up to January 2010. We included randomized controlled trials that compared the use of CCDSSs to usual practice or non-CCDSS controls. Trials were eligible if at least one component of the CCDSS was designed to support chronic disease management. We considered studies 'positive' if they showed a statistically significant improvement in at least 50% of relevant outcomes. Results Of 55 included trials, 87% (n = 48 measured system impact on the process of care and 52% (n = 25 of those demonstrated statistically significant improvements. Sixty-five percent (36/55 of trials measured impact on, typically, non-major (surrogate patient outcomes, and 31% (n = 11 of those demonstrated benefits. Factors of interest to decision makers, such as cost, user satisfaction, system interface and feature sets, unique design and deployment characteristics, and effects on user workflow were rarely investigated or reported. Conclusions A small majority (just over half of CCDSSs improved care processes in chronic disease management and some improved patient health. Policy makers, healthcare administrators, and practitioners should be aware that the evidence of CCDSS effectiveness is limited, especially with respect to the small number and size of studies

  18. Long-term follow-up of childhood cancer survivors: clinical decision support and research participation

    OpenAIRE

    Kilsdonk, E.

    2016-01-01

    The aim of the research in this thesis was twofold. Part 1 aimed to provide insights into how the use of a (paper-based) clinical guideline for follow-up care of childhood cancer survivors could be improved (CCS) by communicating the guideline through a computerized clinical decision support system (CDSS). We first investigated factors that could facilitate a successful CDSS implementation through a systematic literature review. Subsequently, we investigated whether the use of an established ...

  19. A decision-support system for the analysis of clinical practice patterns.

    OpenAIRE

    Balas, E A; Li, Z. R.; Mitchell, J. A.; Spencer, D. C.; Brent, E; Ewigman, B G

    1994-01-01

    Several studies documented substantial variation in medical practice patterns, but physicians often do not have adequate information on the cumulative clinical and financial effects of their decisions. The purpose of developing an expert system for the analysis of clinical practice patterns was to assist providers in analyzing and improving the process and outcome of patient care. The developed QFES (Quality Feedback Expert System) helps users in the definition and evaluation of measurable qu...

  20. Costs, Quality and Value in Cardiovascular Interventions: Implications for clinical decision-making and policy development

    OpenAIRE

    Osnabrugge, Ruben

    2015-01-01

    markdownabstract__Abstract__ The aim of this thesis is to study the clinical, economic and quality-of-life considerations for clinical decision-making and policy development in cardiovascular interventions. More specifi cally the goals are: 1. To investigate the disease prevalence, adoption trends, quality of life, and economic aspects associated with therapies of aortic stenosis. 2. To explore the economic and policy aspects of alternative revascularization therapies for coronary artery dise...

  1. A programmable rules engine to provide clinical decision support using HTML forms.

    OpenAIRE

    Heusinkveld, J.; Geissbuhler, A.; Sheshelidze, D.; Miller, R.

    1999-01-01

    The authors have developed a simple method for specifying rules to be applied to information on HTML forms. This approach allows clinical experts, who lack the programming expertise needed to write CGI scripts, to construct and maintain domain-specific knowledge and ordering capabilities within WizOrder, the order-entry and decision support system used at Vanderbilt Hospital. The clinical knowledge base maintainers use HTML editors to create forms and spreadsheet programs for rule entry. A te...

  2. Development of Clinical Decision Support Systems based on Mathematical Models of Physiological Systems

    OpenAIRE

    Giannessi, Massimo

    2010-01-01

    In the last years of research, I focused my studies on different physiological problems. Together with my supervisors, I developed/improved different mathematical models in order to create valid tools useful for a better understanding of important clinical issues. The aim of all this work is to develop tools for learning and understanding cardiac and cerebrovascular physiology as well as pathology, generating research questions and developing clinical decision support systems useful for in...

  3. Incorporating INTERACT II Clinical Decision Support Tools into Nursing Home Health Information Technology

    OpenAIRE

    Handler, Steven M.; Sharkey, Siobhan S.; Hudak, Sandra; Ouslander, Joseph G.

    2011-01-01

    A substantial reduction in hospitalization rates has been associated with the implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) quality improvement intervention using the accompanying paper-based clinical practice tools (INTERACT II). There is significant potential to further increase the impact of INTERACT by integrating INTERACT II tools into nursing home (NH) health information technology (HIT) via standalone or integrated clinical decision support (CDS) systems...

  4. Development of a Workflow Integration Survey (WIS) for Implementing Computerized Clinical Decision Support

    OpenAIRE

    Flanagan, Mindy; Arbuckle, Nicole; Saleem, Jason J; Militello, Laura G.; Haggstrom, David A.; Doebbeling, Bradley N

    2011-01-01

    Interventions that focus on improving computerized clinical decision support (CDS) demonstrate that successful workflow integration can increase the adoption and use of CDS. However, metrics for assessing workflow integration in clinical settings are not well established. The goal of this study was to develop and validate a survey to assess the extent to which CDS is integrated into workflow. Qualitative data on CDS design, usability, and integration from four sites was collected by direct ob...

  5. On Implementing Clinical Decision Support: Achieving Scalability and Maintainability by Combining Business Rules and Ontologies.

    OpenAIRE

    Kashyap, Vipul; Morales, Alfredo; Hongsermeier, Tonya

    2006-01-01

    We present an approach and architecture for implementing scalable and maintainable clinical decision support at the Partners HealthCare System. The architecture integrates a business rules engine that executes declarative if-then rules stored in a rule-base referencing objects and methods in a business object model. The rules engine executes object methods by invoking services implemented on the clinical data repository. Specialized inferences that support classification of data and instances...

  6. Platelet parameters from an automated hematology analyzer in dogs with inflammatory clinical diseases.

    Science.gov (United States)

    Smith, Jo R; Smith, Katherine F; Brainard, Benjamin M

    2014-09-01

    The mean platelet component (MPC) is a proprietary algorithm of an automated laser-based hematology analyzer system which measures the refractive index of platelets. The MPC is related linearly to platelet density and is an indirect index of platelet activation status. Previous investigations of canine inflammatory conditions and models of endotoxemia demonstrated a significant decrease in the MPC, consistent with platelet activation. The purpose of this study was to evaluate the MPC and other platelet parameters in dogs with different diseases to determine if they could show differential platelet activation with different pathologies. The hypothesis was that the MPC would decrease in clinical conditions associated with systemic inflammation or platelet activation. Complete blood counts run on the analyzer from dogs with different inflammatory conditions (primary immune-mediated hemolytic anemia (IMHA) or thrombocytopenia (ITP), pituitary-dependent hyperadrenocorticism, intra-abdominal sepsis, pancreatitis, intravascular thrombus or thromboembolus and hemangiosarcoma) were reviewed retrospectively and compared with those of control dogs presenting for orthopedic evaluation. Dogs with ITP had a decreased plateletcrit and MPC, with an increased platelet volume and number of large platelets (P Dogs with IMHA had an increased plateletcrit and mass, and more numerous large platelets (P < 0.001).With the exception of the ITP group, there was no difference in MPC in the diseased groups when compared with the controls. The results of this study suggest the MPC does not change in certain canine diseases associated with systemic inflammation. PMID:25082397

  7. Automated percutaneous lumbar discectomy: technique, indications and clinical follow-up in over 1000 patients

    Energy Technology Data Exchange (ETDEWEB)

    Bonaldi, G. [Department of Neuroradiology, Ospedali Riuniti, Bergamo (Italy)

    2003-10-01

    This paper summarises my experience, over 14 years, treating over 1350 patients suffering from lumbar disc pathology, using minimally invasive intradiscal decompressive percutaneous techniques. The vast majority underwent the method introduced by Onik in 1985, referred to as ''automated'' since it involves a mechanical probe, working by a ''suction and cutting'' action for removal of the nucleus pulposus. Postoperative follow-up of at least 6 months was available for 1047 patients aged 15-92 years, who underwent this procedure up to June 2002. Results, based on a patient satisfaction, have been good in 58% of patients at 2 months and in 67.5% at 6 months; they have been particularly favourable in some subgroups such as elderly people (79.5% of excellent or good results), patients previously operated upon (78%) and those with ''discogenic'' low back pain (79%). Complication rates have been extremely low (less than 1%) and all complications cleared up without sequelae. In comparison with other percutaneous disc treatments, Onik's achieves the best compromise between clinical efficacy, comfort for the patient and low invasiveness. (orig.)

  8. Evaluating a Clinical Decision Support Interface for End-of-Life Nurse Care

    Science.gov (United States)

    Febretti, Alessandro; Stifter, Janet; Keenan, Gail M; Lopez, Karen D; Johnson, Andrew; Wilkie, Diana J

    2016-01-01

    Clinical Decision Support Systems (CDSS) are tools that assist healthcare personnel in the decision-making process for patient care. Although CDSSs have been successfully deployed in the clinical setting to assist physicians, few CDSS have been targeted at professional nurses, the largest group of health providers. We present our experience in designing and testing a CDSS interface embedded within a nurse care planning and documentation tool. We developed four prototypes based on different CDSS feature designs, and tested them in simulated end-of-life patient handoff sessions with a group of 40 nurse clinicians. We show how our prototypes directed nurses towards an optimal care decision that was rarely performed in unassisted practice. We also discuss the effect of CDSS layout and interface navigation in a nurse’s acceptance of suggested actions. These findings provide insights into effective nursing CDSS design that are generalizable to care scenarios different than end-of-life.

  9. Knowledge of risk factors and the periodontal disease-systemic link in dental students' clinical decisions.

    Science.gov (United States)

    Friesen, Lynn Roosa; Walker, Mary P; Kisling, Rebecca E; Liu, Ying; Williams, Karen B

    2014-09-01

    This study evaluated second-, third-, and fourth-year dental students' ability to identify systemic conditions associated with periodontal disease, risk factors most important for referral, and medications with an effect on the periodontium and their ability to apply this knowledge to make clinical decisions regarding treatment and referral of periodontal patients. A twenty-one question survey was administered at one U.S. dental school in the spring semester of 2012 to elicit the students' knowledge and confidence regarding clinical reasoning. The response rate was 86 percent. Periodontal risk factors were accurately selected by at least 50 percent of students in all three classes; these were poorly controlled diabetes, ≥6 mm pockets posteriorly, and lack of response to previous non-surgical therapy. Confidence in knowledge, knowledge of risk factors, and knowledge of medications with an effect on the periodontium improved with training and were predictive of better referral decision making. The greatest impact of training was seen on the students' ability to make correct decisions about referral and treatment for seven clinical scenarios. Although the study found a large increase in the students' abilities from the second through fourth years, the mean of 4.6 (out of 7) for the fourth-year students shows that, on average, those students missed correct treatment or referral on more than two of seven clinical cases. These results suggest that dental curricula should emphasize more critical decision making with respect to referral and treatment criteria in managing the periodontal patient. PMID:25179920

  10. Students' Stereotypes of Patients as Barriers to Clinical Decision-Making.

    Science.gov (United States)

    Johnson, Shirley M.; And Others

    1986-01-01

    At the Michigan State University College of Osteopathic Medicine, a study was designed that graphically illustrated to beginning students that unconscious sociocultural stereotypes may influence clinical decision-making. Students were shown a videotape depicting five simulated patients, each with the same physical complaint. (Author/MLW)

  11. Clinical decision-making to facilitate appropriate patient management in chiropractic practice: 'the 3-questions model'

    Directory of Open Access Journals (Sweden)

    Amorin-Woods Lyndon G

    2012-03-01

    Full Text Available Abstract Background A definitive diagnosis in chiropractic clinical practice is frequently elusive, yet decisions around management are still necessary. Often, a clinical impression is made after the exclusion of serious illness or injury, and care provided within the context of diagnostic uncertainty. Rather than focussing on labelling the condition, the clinician may choose to develop a defendable management plan since the response to treatment often clarifies the diagnosis. Discussion This paper explores the concept and elements of defensive problem-solving practice, with a view to developing a model of agile, pragmatic decision-making amenable to real-world application. A theoretical framework that reflects the elements of this approach will be offered in order to validate the potential of a so called '3-Questions Model'; Summary Clinical decision-making is considered to be a key characteristic of any modern healthcare practitioner. It is, thus, prudent for chiropractors to re-visit the concept of defensible practice with a view to facilitate capable clinical decision-making and competent patient examination skills. In turn, the perception of competence and trustworthiness of chiropractors within the wider healthcare community helps integration of chiropractic services into broader healthcare settings.

  12. Improving Emergency Department Triage Classification with Computerized Clinical Decision Support at a Pediatric Hospital

    Science.gov (United States)

    Kunisch, Joseph Martin

    2012-01-01

    Background: The Emergency Severity Index (ESI) is an emergency department (ED) triage classification system based on estimated patient-specific resource utilization. Rules for a computerized clinical decision support (CDS) system based on a patient's chief complaint were developed and tested using a stochastic model for predicting ESI scores.…

  13. Automated ancillary cancer history classification for mesothelioma patients from free-text clinical reports

    Directory of Open Access Journals (Sweden)

    Richard A Wilson

    2010-01-01

    Full Text Available Background: Clinical records are often unstructured, free-text documents that create information extraction challenges and costs. Healthcare delivery and research organizations, such as the National Mesothelioma Virtual Bank, require the aggregation of both structured and unstructured data types. Natural language processing offers techniques for automatically extracting information from unstructured, free-text documents. Methods: Five hundred and eight history and physical reports from mesothelioma patients were split into development (208 and test sets (300. A reference standard was developed and each report was annotated by experts with regard to the patient′s personal history of ancillary cancer and family history of any cancer. The Hx application was developed to process reports, extract relevant features, perform reference resolution and classify them with regard to cancer history. Two methods, Dynamic-Window and ConText, for extracting information were evaluated. Hx′s classification responses using each of the two methods were measured against the reference standard. The average Cohen′s weighted kappa served as the human benchmark in evaluating the system. Results: Hx had a high overall accuracy, with each method, scoring 96.2%. F-measures using the Dynamic-Window and ConText methods were 91.8% and 91.6%, which were comparable to the human benchmark of 92.8%. For the personal history classification, Dynamic-Window scored highest with 89.2% and for the family history classification, ConText scored highest with 97.6%, in which both methods were comparable to the human benchmark of 88.3% and 97.2%, respectively. Conclusion: We evaluated an automated application′s performance in classifying a mesothelioma patient′s personal and family history of cancer from clinical reports. To do so, the Hx application must process reports, identify cancer concepts, distinguish the known mesothelioma from ancillary cancers, recognize negation

  14. Two Methods for High-Throughput NGS Template Preparation for Small and Degraded Clinical Samples Without Automation

    OpenAIRE

    Kamberov, E.; Tesmer, T.; Mastronardi, M.; Langmore, John

    2012-01-01

    Clinical samples are difficult to prepare for NGS, because of the small amounts or degraded states of formalin-fixed tissue, plasma, urine, and single-cell DNA. Conventional whole genome amplification methods are too biased for NGS applications, and the existing NGS preparation kits require intermediate purifications and excessive time to prepare hundreds of samples in a day without expensive automation. We have tested two 96-well manual methods to make NGS templates from FFPE tissue, plasma,...

  15. Preparing Electronic Clinical Data for Quality Improvement and Comparative Effectiveness Research: The SCOAP CERTAIN Automation and Validation Project

    Science.gov (United States)

    Devine, Emily Beth; Capurro, Daniel; van Eaton, Erik; Alfonso-Cristancho, Rafael; Devlin, Allison; Yanez, N. David; Yetisgen-Yildiz, Meliha; Flum, David R.; Tarczy-Hornoch, Peter

    2013-01-01

    Background: The field of clinical research informatics includes creation of clinical data repositories (CDRs) used to conduct quality improvement (QI) activities and comparative effectiveness research (CER). Ideally, CDR data are accurately and directly abstracted from disparate electronic health records (EHRs), across diverse health-systems. Objective: Investigators from Washington State’s Surgical Care Outcomes and Assessment Program (SCOAP) Comparative Effectiveness Research Translation Network (CERTAIN) are creating such a CDR. This manuscript describes the automation and validation methods used to create this digital infrastructure. Methods: SCOAP is a QI benchmarking initiative. Data are manually abstracted from EHRs and entered into a data management system. CERTAIN investigators are now deploying Caradigm’s Amalga™ tool to facilitate automated abstraction of data from multiple, disparate EHRs. Concordance is calculated to compare data automatically to manually abstracted. Performance measures are calculated between Amalga and each parent EHR. Validation takes place in repeated loops, with improvements made over time. When automated abstraction reaches the current benchmark for abstraction accuracy - 95% - itwill ‘go-live’ at each site. Progress to Date: A technical analysis was completed at 14 sites. Five sites are contributing; the remaining sites prioritized meeting Meaningful Use criteria. Participating sites are contributing 15–18 unique data feeds, totaling 13 surgical registry use cases. Common feeds are registration, laboratory, transcription/dictation, radiology, and medications. Approximately 50% of 1,320 designated data elements are being automatically abstracted—25% from structured data; 25% from text mining. Conclusion: In semi-automating data abstraction and conducting a rigorous validation, CERTAIN investigators will semi-automate data collection to conduct QI and CER, while advancing the Learning Healthcare System. PMID:25848565

  16. Consensus Recommendations for Systematic Evaluation of Drug-Drug Interaction Evidence for Clinical Decision Support

    Science.gov (United States)

    Scheife, Richard T.; Hines, Lisa E.; Boyce, Richard D.; Chung, Sophie P.; Momper, Jeremiah; Sommer, Christine D.; Abernethy, Darrell R.; Horn, John; Sklar, Stephen J.; Wong, Samantha K.; Jones, Gretchen; Brown, Mary; Grizzle, Amy J.; Comes, Susan; Wilkins, Tricia Lee; Borst, Clarissa; Wittie, Michael A.; Rich, Alissa; Malone, Daniel C.

    2015-01-01

    Background Healthcare organizations, compendia, and drug knowledgebase vendors use varying methods to evaluate and synthesize evidence on drug-drug interactions (DDIs). This situation has a negative effect on electronic prescribing and medication information systems that warn clinicians of potentially harmful medication combinations. Objective To provide recommendations for systematic evaluation of evidence from the scientific literature, drug product labeling, and regulatory documents with respect to DDIs for clinical decision support. Methods A conference series was conducted to develop a structured process to improve the quality of DDI alerting systems. Three expert workgroups were assembled to address the goals of the conference. The Evidence Workgroup consisted of 15 individuals with expertise in pharmacology, drug information, biomedical informatics, and clinical decision support. Workgroup members met via webinar from January 2013 to February 2014. Two in-person meetings were conducted in May and September 2013 to reach consensus on recommendations. Results We developed expert-consensus answers to three key questions: 1) What is the best approach to evaluate DDI evidence?; 2) What evidence is required for a DDI to be applicable to an entire class of drugs?; and 3) How should a structured evaluation process be vetted and validated? Conclusion Evidence-based decision support for DDIs requires consistent application of transparent and systematic methods to evaluate the evidence. Drug information systems that implement these recommendations should be able to provide higher quality information about DDIs in drug compendia and clinical decision support tools. PMID:25556085

  17. Comprehensive and Scalable Highly Automated MS-Based Proteomic Workflow for Clinical Biomarker Discovery in Human Plasma.

    Science.gov (United States)

    Dayon, Loïc; Núñez Galindo, Antonio; Corthésy, John; Cominetti, Ornella; Kussmann, Martin

    2014-07-24

    Over the past decade, mass spectrometric performance has greatly improved in terms of sensitivity, dynamic range, and speed. By contrast, only limited progress has been accomplished with regard to automation, throughput, and robustness of the proteomic sample preparation process upstream of mass spectrometry. The present work delivers an optimized analysis of human plasma samples in both small preclinical and large clinical studies, enabled by the development of a highly automated quantitative proteomic workflow. Several iterative evaluation and validation steps were performed before process "design freeze" and development completion. A robotic liquid handling workflow and platform (including reduction, alkylation, digestion, TMT labeling, pooling, and purification) were shown to provide better quantitative trueness and precision than manual operation at the bench. Depletion of the most abundant human plasma proteins and subsequent buffer exchange were also developed and integrated. Finally, 96 identical pooled human plasma samples were prepared in a 96-well plate format, and each sample was individually subjected to our developed workflow. This test revealed increased throughput and robustness compared with to-date published manual or less automated workflows. Our workflow is ready-to-use for future (pre-) clinical studies. We expect our work to facilitate, accelerate, and improve clinical proteomic discovery in human blood plasma. PMID:25058407

  18. Decision theory and the evaluation of risks and benefits of clinical trials.

    Science.gov (United States)

    Bernabe, Rosemarie D C; van Thiel, Ghislaine J M W; Raaijmakers, Jan A M; van Delden, Johannes J M

    2012-12-01

    Research ethics committees (RECs) are tasked to assess the risks and the benefits of a clinical trial. In previous studies, it was shown that RECs find this task difficult, if not impossible, to do. The current approaches to benefit-risk assessment (i.e. Component Analysis and the Net Risk Test) confound the various risk-benefit tasks, and as such, make balancing impossible. In this article, we show that decision theory, specifically through the expected utility theory and multiattribute utility theory, enable for an explicit and ethically weighted risk-benefit evaluation. This makes a balanced ethical justification possible, and thus a more rationally defensible decision making. PMID:22819925

  19. Improving Decision Making about Genetic Testing in the Clinic: An Overview of Effective Knowledge Translation Interventions

    Science.gov (United States)

    Légaré, France; Robitaille, Hubert; Gane, Claire; Hébert, Jessica; Labrecque, Michel; Rousseau, François

    2016-01-01

    Background Knowledge translation (KT) interventions are attempts to change behavior in keeping with scientific evidence. While genetic tests are increasingly available to healthcare consumers in the clinic, evidence about their benefits is unclear and decisions about genetic testing are thus difficult for all parties. Objective We sought to identify KT interventions that involved decisions about genetic testing in the clinical context and to assess their effectiveness for improving decision making in terms of behavior change, increased knowledge and wellbeing. Methods We searched for trials assessing KT interventions in the context of genetic testing up to March 2014 in all systematic reviews (n = 153) published by two Cochrane review groups: Effective Practice and Organisation of Care (EPOC) and Consumers and Communication. Results We retrieved 2473 unique trials of which we retained only 28 (1%). Two EPOC reviews yielded two trials of KT interventions: audit and feedback (n = 1) and educational outreach (n = 1). Both targeted health professionals and the KT intervention they assessed was found to be effective. Four Consumers and Communication reviews yielded 26 trials: decision aids (n = 15), communication of DNA-based disease risk estimates (n = 7), personalized risk communication (n = 3) and mobile phone messaging (n = 1). Among these, 25 trials targeted only health consumers or patients and the KT interventions were found to be effective in four trials, partly effective in seven, and ineffective in four. Lastly, only one trial targeted both physicians and patients and was found to be effective. Conclusions More research on the effectiveness of KT interventions regarding genetic testing in the clinical context may contribute to patients making informed value-based decisions and drawing the maximum benefit from clinical applications of genetic and genomic innovations. PMID:26938633

  20. Clinical decision support for whole genome sequence information leveraging a service-oriented architecture: a prototype.

    Science.gov (United States)

    Welch, Brandon M; Rodriguez-Loya, Salvador; Eilbeck, Karen; Kawamoto, Kensaku

    2014-01-01

    Whole genome sequence (WGS) information could soon be routinely available to clinicians to support the personalized care of their patients. At such time, clinical decision support (CDS) integrated into the clinical workflow will likely be necessary to support genome-guided clinical care. Nevertheless, developing CDS capabilities for WGS information presents many unique challenges that need to be overcome for such approaches to be effective. In this manuscript, we describe the development of a prototype CDS system that is capable of providing genome-guided CDS at the point of care and within the clinical workflow. To demonstrate the functionality of this prototype, we implemented a clinical scenario of a hypothetical patient at high risk for Lynch Syndrome based on his genomic information. We demonstrate that this system can effectively use service-oriented architecture principles and standards-based components to deliver point of care CDS for WGS information in real-time. PMID:25954430

  1. Towards Automation 2.0: A Neurocognitive Model for Environment Recognition, Decision-Making, and Action Execution

    OpenAIRE

    Zucker Gerhard; Dietrich Dietmar; Velik Rosemarie

    2011-01-01

    The ongoing penetration of building automation by information technology is by far not saturated. Today's systems need not only be reliable and fault tolerant, they also have to regard energy efficiency and flexibility in the overall consumption. Meeting the quality and comfort goals in building automation while at the same time optimizing towards energy, carbon footprint and cost-efficiency requires systems that are able to handle large amounts of information and negotiate system behaviour ...

  2. The Use of Intuition in Homeopathic Clinical Decision Making: An Interpretative Phenomenological Study

    Directory of Open Access Journals (Sweden)

    Sarah Brien

    2011-01-01

    Full Text Available While intuition plays a role in clinical decision making within conventional medicine, little is understood about its use in complementary and alternative medicine (CAM. The aim of this qualitative study was to investigate intuition from the perspective of homeopathic practitioners; its’ manifestation, how it was recognized, its origins and when it was used within daily clinical practice. Semi-structured interviews were carried out with clinically experienced non-National Health Service (NHS UK homeopathic practitioners. Interpretative phenomenological analysis was used to analyze the data. Homeopaths reported many similarities with conventional medical practitioner regarding the nature, perceived origin and manifestation of their intuitions in clinical practice. Intuition was used in two key aspects of the consultation: (i to enhance the practitioner-patient relationship, these were generally trusted; and (ii intuitions relating to the prescribing decision. Homeopaths were cautious about these latter intuitions, testing any intuitive thoughts through deductive reasoning before accepting them. Their reluctance is not surprising given the consequences for patient care, but we propose this also reflects homeopaths’ sensitivity to the academic and medical mistrust of both homeopathy and intuition. This study is the first to explore the use of intuition in decision making in any form of complementary medicine. The similarities with conventional practitioners may provide confidence in validating intuition as a legitimate part of the decision making process for these specific practitioners. Further work is needed to elucidate if these findings reflect intuitive use in clinical practice of other CAM practitioners in both private and NHS (i.e., time limited settings.

  3. Designing a Clinical Framework to Guide Gross Motor Intervention Decisions for Infants and Young Children with Hypotonia

    Science.gov (United States)

    Darrah, Johanna; O'Donnell, Maureen; Lam, Joyce; Story, Maureen; Wickenheiser, Diane; Xu, Kaishou; Jin, Xiaokun

    2013-01-01

    Clinical practice frameworks are a valuable component of clinical education, promoting informed clinical decision making based on the best available evidence and/or clinical experience. They encourage standardized intervention approaches and evaluation of practice. Based on an international project to support the development of an enhanced service…

  4. Multi-site evaluation of a clinical decision support system for radiation therapy

    Science.gov (United States)

    Deshpande, Ruchi; DeMarco, John; Kessel, Kerstin; Liu, Brent J.

    2016-03-01

    We have developed an imaging informatics based decision support system that learns from retrospective treatment plans to provide recommendations for healthy tissue sparing to prospective incoming patients. This system incorporates a model of best practices from previous cases, specific to tumor anatomy. Ultimately, our hope is to improve clinical workflow efficiency, patient outcomes and to increase clinician confidence in decision-making. The success of such a system depends greatly on the training dataset, which in this case, is the knowledge base that the data-mining algorithm employs. The size and heterogeneity of the database is essential for good performance. Since most institutions employ standard protocols and practices for treatment planning, the diversity of this database can be greatly increased by including data from different institutions. This work presents the results of incorporating cross-country, multi-institutional data into our decision support system for evaluation and testing.

  5. Development and evaluation of a computerised clinical decision support system for switching drugs at the interface between primary and tertiary care

    Directory of Open Access Journals (Sweden)

    Pruszydlo Markus G

    2012-11-01

    Full Text Available Abstract Background Upon admission to a hospital patients’ medications are frequently switched to alternative drugs compiled in so called hospital drug formularies. This substitution process is a laborious and error-prone task which should be supported by sophisticated electronic tools. We developed a computerised decision support system and evaluated benefit and potential harm associated with its use. Methods Based on a multi-step algorithm we identified drug classes suitable for exchange, defined conversion factors for therapeutic interchange, built a web-based decision support system, and implemented it into the computerised physician order entry of a large university hospital. For evaluation we compared medications manually switched by clinical pharmacists with the results of automated switching by the newly developed computer system and optimised the system in an iterative process. Thereafter the final system was tested in an independent set of prescriptions. Results After iterative optimisation of the logical framework the tool was able to switch drugs to pharmaceutical equivalents and alternatives; in addition, it contained 21 different drug classes for therapeutic substitution. In this final version it switched 91.6% of 202 documented medication consultations (containing 1,333 drugs automatically, leaving 8.4% for manual processing by clinical professionals. No incorrect drug switches were found. Conclusion A large majority (>90% of drug switches performed at the interface between primary and tertiary care can be handled automatically using electronic decision support systems, indicating that medication errors and workload of healthcare professionals can be considerably reduced.

  6. THE IMPACT OF RACISM ON CLINICIAN COGNITION, BEHAVIOR, AND CLINICAL DECISION MAKING

    Science.gov (United States)

    van Ryn, Michelle; Burgess, Diana J.; Dovidio, John F.; Phelan, Sean M.; Saha, Somnath; Malat, Jennifer; Griffin, Joan M.; Fu, Steven S.; Perry, Sylvia

    2014-01-01

    Over the past two decades, thousands of studies have demonstrated that Blacks receive lower quality medical care than Whites, independent of disease status, setting, insurance, and other clinically relevant factors. Despite this, there has been little progress towards eradicating these inequities. Almost a decade ago we proposed a conceptual model identifying mechanisms through which clinicians’ behavior, cognition, and decision making might be influenced by implicit racial biases and explicit racial stereotypes, and thereby contribute to racial inequities in care. Empirical evidence has supported many of these hypothesized mechanisms, demonstrating that White medical care clinicians: (1) hold negative implicit racial biases and explicit racial stereotypes, (2) have implicit racial biases that persist independently of and in contrast to their explicit (conscious) racial attitudes, and (3) can be influenced by racial bias in their clinical decision making and behavior during encounters with Black patients. This paper applies evidence from several disciplines to further specify our original model and elaborate on the ways racism can interact with cognitive biases to affect clinicians’ behavior and decisions and in turn, patient behavior and decisions. We then highlight avenues for intervention and make specific recommendations to medical care and grant-making organizations. PMID:24761152

  7. Decision making and senior management: the implementation of change projects covering clinical management in SUS hospitals.

    Science.gov (United States)

    Pacheco, José Márcio da Cunha; Gomes, Romeu

    2016-08-01

    This paper analyses the decision making process for senior management in public hospitals that are a part of the National Health Service in Brazil (hereafter SUS) in relation to projects aimed at changing clinical management. The methodological design of this study is qualitative in nature taking a hermeneutics-dialectics perspective in terms of results. Hospital directors noted that clinical management projects changed the state of hospitals through: improving their organizations, mobilizing their staff in order to increase a sense of order and systemizing actions and available resources. Technical rationality was the principal basis used in the decision making process for managers. Due to the reality of many hospitals having fragmented organizations, this fact impeded the use of aspects related to rationality, such as economic and financial factors in the decision making process. The incremental model and general politics also play a role in this area. We concluded that the decision making process embraces a large array of factors including rational aspects such as the use of management techniques and the ability to analyze, interpret and summarize. It also incorporates subjective elements such as how to select values and dealing with people's working experiences. We recognized that management problems are wide in scope, ambiguous, complex and do not come with a lot of structure in practice. PMID:27557021

  8. How Qualitative Research Informs Clinical and Policy Decision Making in Transplantation: A Review.

    Science.gov (United States)

    Tong, Allison; Morton, Rachael L; Webster, Angela C

    2016-09-01

    Patient-centered care is no longer just a buzzword. It is now widely touted as a cornerstone in delivering quality care across all fields of medicine. However, patient-centered strategies and interventions necessitate evidence about patients' decision-making processes, values, priorities, and needs. Qualitative research is particularly well suited to understanding the experience and perspective of patients, donors, clinicians, and policy makers on a wide range of transplantation-related topics including organ donation and allocation, adherence to prescribed therapy, pretransplant and posttransplant care, implementation of clinical guidelines, and doctor-patient communication. In transplantation, evidence derived from qualitative research has been integrated into strategies for shared decision-making, patient educational resources, process evaluations of trials, clinical guidelines, and policies. The aim of this article is to outline key concepts and methods used in qualitative research, guide the appraisal of qualitative studies, and assist clinicians to understand how qualitative research may inform their practice and policy. PMID:27479165

  9. The Morningside Initiative: Collaborative Development of a Knowledge Repository to Accelerate Adoption of Clinical Decision Support

    OpenAIRE

    Greenes, Robert; Bloomrosen, Meryl; Brown-Connolly, Nancy E.; Curtis, Clayton; Detmer, Don E.; Enberg, Robert; Fridsma, Douglas; Fry, Emory; Goldstein, Mary K.; Haug, Peter; Hulse, Nathan; Hongsermeier, Tonya; Maviglia, Saverio; Robbins, Craig W; Shah, Hemant

    2010-01-01

    The Morningside Initiative is a public-private activity that has evolved from an August, 2007, meeting at the Morningside Inn, in Frederick, MD, sponsored by the Telemedicine and Advanced Technology Research Center (TATRC) of the US Army Medical Research Materiel Command. Participants were subject matter experts in clinical decision support (CDS) and included representatives from the Department of Defense, Veterans Health Administration, Kaiser Permanente, Partners Healthcare System, Henry Fo...

  10. Overview of the second workshop on medical content–based retrieval for clinical decision support

    OpenAIRE

    Depeursinge A.; Greenspan H.; Syeda T.; Muller H.

    2013-01-01

    The second workshop on Medical Content–Based Retrieval for Clinical Decision Support took place at the MICCAI conference in Toronto, Canada on September 22, 2011. The workshop brought together more than 40 registered researchers interested in the field of medical content–based retrieval. Eleven papers were accepted and presented at the workshop. Two invited speakers gave overviews on state–of–the–art academic research and industrial perspectives. The program was completed with a panel discuss...

  11. Use of Clinical Decision Support to Increase Influenza Vaccination: Multi-year Evolution of the System

    OpenAIRE

    Gerard, Mary N.; Trick, William E.; Das, Krishna; Charles-Damte, Marjorie; Murphy, Gregory A.; Benson, Irene M.

    2008-01-01

    Despite recognition that clinical decision support (CDS) can improve patient care, there has been poor penetration of this technology into healthcare settings. We used CDS to increase inpatient influenza vaccination during implementation of an electronic medical record, in which pharmacy and nursing transactions increasingly became electronic. Over three influenza seasons we evaluated standing orders, provider reminders, and pre-selected physician orders. A pre-intervention cross-sectional su...

  12. Improving Appropriateness of Acid-Suppressive Medication Use Via Computerized Clinical Decision Support

    OpenAIRE

    Herzig, Shoshana J.; Guess, Jamey R.; Feinbloom, David B.; Adra, May; Afonso, Kevin A.; Howell, Michael D.; Edward R. Marcantonio

    2015-01-01

    As part of the Choosing Wisely Campaign, the Society of Hospital Medicine identified reducing inappropriate use of acid-suppressive medication for stress ulcer prophylaxis as one of 5 key opportunities to improve the value of care for hospitalized patients. We designed a computerized clinical decision support intervention to reduce use of acid-suppressive medication for stress ulcer prophylaxis in hospitalized patients outside of the intensive care unit at an academic medical center. Using qu...

  13. Editorial: The search for core symptoms - will this help clinical decision-making?

    Science.gov (United States)

    Frazier Norbury, Courtenay

    2016-08-01

    Diagnosis is an important component of our clinical roles, and should also lead to particular treatment pathways. The diagnostic process may be challenged by co-occurring deficits that are neither specific nor universal to the diagnosis under consideration and may well be evident across a range of other clinical conditions. How important is it to refine our instruments so that they measure unique symptoms? Will this alter or improve intervention choices? This Editorial focuses on the extent to which fine tuning diagnostic instruments improves our decisions about treatment, in the context of articles published in this issue of JCPP. PMID:27445109

  14. EHRs Connect Research and Practice: Where Predictive Modeling, Artificial Intelligence, and Clinical Decision Support Intersect

    CERN Document Server

    Bennett, Casey; Selove, Rebecca

    2012-01-01

    Objectives: Electronic health records (EHRs) are only a first step in capturing and utilizing health-related data - the challenge is turning that data into useful information. Furthermore, EHRs are increasingly likely to include data relating to patient outcomes, functionality such as clinical decision support, and genetic information as well, and, as such, can be seen as repositories of increasingly valuable information about patients' health conditions and responses to treatment over time. Methods: We describe a case study of 423 patients treated by Centerstone within Tennessee and Indiana in which we utilized electronic health record data to generate predictive algorithms of individual patient treatment response. Multiple models were constructed using predictor variables derived from clinical, financial and geographic data. Results: For the 423 patients, 101 deteriorated, 223 improved and in 99 there was no change in clinical condition. Based on modeling of various clinical indicators at baseline, the high...

  15. The effect of concept mapping on clinical decision making skills of ICU nurses

    Directory of Open Access Journals (Sweden)

    Fakhri Dokht Akbari

    2014-10-01

    Full Text Available Introduction: Concept mapping is an innovative tool that would help hospital educators and nurses to promote their knowledge and clinical decision making skills. The aim of this study was to investigate the effect of concept mapping on clinical decision making skills of nurses working in the intensive care unit (ICU. Methods: The quasi-experimental, non-equivalent control group, pretest-posttest design was conducted among baccalaureate nurses working in an intensive care unit. Forty two nurses were recruited and data gathering was performed through a self-administered questionnaire. Statistical analysis was conducted by SPSS software package version 16.0. Results: Despite the significant difference between the mean pre-, post- and retention test scores (P<0.001, there was no significant correlation between these results and the nurses’ gender. A negative significant association was found between age and improved post test scores (P=0.02. Work experience had a significant positive effect on post test score improvement (P<0.001. Conclusion: This study revealed that the concept mapping strategy had a significant effect on the clinical decision making skills of nurses. However, further research on a larger sample size is recommended to confirm the results.

  16. A collaborative teaching strategy for enhancing learning of evidence-based clinical decision-making.

    Science.gov (United States)

    Scott, P J; Altenburger, P A; Kean, J

    2011-01-01

    The educational literature cites a lack of student motivation to learn how to use research evidence in clinical decision-making because the students do not observe clinicians using evidence. This lack of motivation presents a challenge to educators as they seek to instill the value of evidence-based clinical decision-making (EBCD) in students. One problem is that students in entry-level programs do not have the experience needed to know what to look for, and secondly, clinical decision-making is contextually based in a patient problem. Our approach offers one solution to bridging the gap between classroom teaching and real-world implementation of EBCD through a three-phase collaborative approach. Occupational and physical therapy students are partnered with clinicians to find and appraise evidence to answer the real-world questions posed by these therapists. This paper describes the implementation of the partnership, teaching/learning outcomes, logistics, and implications for clinicians. We found this approach increased student motivation and greatly enhanced the learning experience. Future directions include implementing a framework which allows for the assessment of the strategy on the facility and creates opportunities to integrate the use of EBCD in all aspects of facility practice. PMID:21927777

  17. Effects of Clinical Decision Topic on Patients' Involvement in and Satisfaction With Decisions and Their Subsequent Implementation

    DEFF Research Database (Denmark)

    Freidl, Marion; Pesola, Francesca; Konrad, Jana; Puschner, Bernd; Kovacs, Attila Istvan; Corrado, Rosa; Fiorillo, Andrea; Bording, Malene Frøkjær Krogsgaard; Kawohl, Wolfram; Rössler, Wulf; Nagy, Marietta; Munk-Jørgensen, Povl; Slade, Mike

    2016-01-01

    categories of decision topics were determined: treatment (most frequently cited), social, and financial. The topic identified as most important remained stable over the follow-up. Patients were more likely to rate their involvement as active rather than passive for social decisions (odds ratio [OR]=5.7, p......<.001) and financial decisions (OR=9.5, p<.001). They were more likely to report higher levels of satisfaction rather than lower levels for social decisions (OR=1.5, p=.01) and financial decisions (OR=1.7, p=.01). Social decisions were more likely to be partly implemented (OR=3.0, p<.001) or fully...... implemented (OR=1.7, p=.03) than not implemented. CONCLUSIONS: Patients reported poorer involvement, satisfaction, and implementation in regard to treatment-related decisions, compared with social and financial decisions. Clinicians may need to employ different interactional styles for different types of...

  18. Interoperability of clinical decision-support systems and electronic health records using archetypes: a case study in clinical trial eligibility.

    Science.gov (United States)

    Marcos, Mar; Maldonado, Jose A; Martínez-Salvador, Begoña; Boscá, Diego; Robles, Montserrat

    2013-08-01

    Clinical decision-support systems (CDSSs) comprise systems as diverse as sophisticated platforms to store and manage clinical data, tools to alert clinicians of problematic situations, or decision-making tools to assist clinicians. Irrespective of the kind of decision-support task CDSSs should be smoothly integrated within the clinical information system, interacting with other components, in particular with the electronic health record (EHR). However, despite decades of developments, most CDSSs lack interoperability features. We deal with the interoperability problem of CDSSs and EHRs by exploiting the dual-model methodology. This methodology distinguishes a reference model and archetypes. A reference model is represented by a stable and small object-oriented model that describes the generic properties of health record information. For their part, archetypes are reusable and domain-specific definitions of clinical concepts in the form of structured and constrained combinations of the entities of the reference model. We rely on archetypes to make the CDSS compatible with EHRs from different institutions. Concretely, we use archetypes for modelling the clinical concepts that the CDSS requires, in conjunction with a series of knowledge-intensive mappings relating the archetypes to the data sources (EHR and/or other archetypes) they depend on. We introduce a comprehensive approach, including a set of tools as well as methodological guidelines, to deal with the interoperability of CDSSs and EHRs based on archetypes. Archetypes are used to build a conceptual layer of the kind of a virtual health record (VHR) over the EHR whose contents need to be integrated and used in the CDSS, associating them with structural and terminology-based semantics. Subsequently, the archetypes are mapped to the EHR by means of an expressive mapping language and specific-purpose tools. We also describe a case study where the tools and methodology have been employed in a CDSS to support

  19. Are patient decision aids the best way to improve clinical decision making? Report of the IPDAS Symposium.

    NARCIS (Netherlands)

    Holmes-Rovner, M.; Nelson, W.L.; Pignone, M.; Elwyn, G.; Rovner, D.; O'Connor, A.M.; Coulter, A.; Correa-de-Araujo, R.

    2007-01-01

    This article reports on the International Patient Decision Aid Standards Symposium held in 2006 at the annual meeting of the Society for Medical Decision Making in Cambridge, Massachusetts. The symposium featured a debate regarding the proposition that "decision aids are the best way to improve clin

  20. Formative Evaluation of Clinician Experience with Integrating Family History-Based Clinical Decision Support into Clinical Practice

    Directory of Open Access Journals (Sweden)

    Megan Doerr

    2014-03-01

    Full Text Available Family health history is a leading predictor of disease risk. Nonetheless, it is underutilized to guide care and, therefore, is ripe for health information technology intervention. To fill the family health history practice gap, Cleveland Clinic has developed a family health history collection and clinical decision support tool, MyFamily. This report describes the impact and process of implementing MyFamily into primary care, cancer survivorship and cancer genetics clinics. Ten providers participated in semi-structured interviews that were analyzed to identify opportunities for process improvement. Participants universally noted positive effects on patient care, including increases in quality, personalization of care and patient engagement. The impact on clinical workflow varied by practice setting, with differences observed in the ease of integration and the use of specific report elements. Tension between the length of the report and desired detail was appreciated. Barriers and facilitators to the process of implementation were noted, dominated by the theme of increased integration with the electronic medical record. These results fed real-time improvement cycles to reinforce clinician use. This model will be applied in future institutional efforts to integrate clinical genomic applications into practice and may be useful for other institutions considering the implementation of tools for personalizing medical management.

  1. Reproductive Ethics in Commercial Surrogacy: Decision-Making in IVF Clinics in New Delhi, India.

    Science.gov (United States)

    Tanderup, Malene; Reddy, Sunita; Patel, Tulsi; Nielsen, Birgitte Bruun

    2015-09-01

    As a neo-liberal economy, India has become one of the new health tourism destinations, with commercial gestational surrogacy as an expanding market. Yet the Indian Assisted Reproductive Technology (ART) Bill has been pending for five years, and the guidelines issued by the Indian Council of Medical Research are somewhat vague and contradictory, resulting in self-regulated practices of fertility clinics. This paper broadly looks at clinical ethics in reproduction in the practice of surrogacy and decision-making in various procedures. Through empirical research in New Delhi, the capital of India, from December 2011 to November 2012, issues of decision-making on embryo transfer, fetal reduction, and mode of delivery were identified. Interviews were carried out with doctors in eighteen ART clinics, agents from four agencies, and fourteen surrogates. In aiming to fulfil the commissioning parents' demands, doctors were willing to go to the greatest extent possible in their medical practice. Autonomy and decision-making regarding choice of the number of embryos to transfer and the mode of delivery lay neither with commissioning parents nor surrogate mothers but mostly with doctors. In order to ensure higher success rates, surrogates faced the risk of multiple pregnancy and fetal reduction with little information regarding the risks involved. In the globalized market of commercial surrogacy in India, and with clinics compromising on ethics, there is an urgent need for formulation of regulative law for the clinical practice and maintenance of principles of reproductive ethics in order to ensure that the interests of surrogate mothers are safeguarded. PMID:26133889

  2. Clinical Recommendations in Medical Practice: A Proposed Framework to Reduce Bias and Improve the Quality of Medical Decisions.

    Science.gov (United States)

    Alfandre, David

    2016-01-01

    Patients rely on, benefit from, and are strongly influenced by physicians' recommendations. In spite of the centrality and importance of physicians' recommendations to clinical care, there is only a scant literature describing the conceptual process of forming a clinical recommendation, and no discrete professional standards for making individual clinical recommendations. Evidence-based medicine and shared decision making together are intended to improve medical decision making, but there has been limited attention to how a recommendation is discretely formulated from either of those processes or how patients' preferences ought to be considered and how much weight they should hold. Moreover, physicians' bias has been reported to strongly influence how a recommendation is derived, thereby undermining the quality of healthcare decisions and patients' trust. To demonstrate a potential for improving the quality of decisions, this article proposes a conceptual framework for how physicians should reach a clinical recommendation and apply the process in practice. For preference-sensitive clinical decisions-that is, clinical decisions when patients' values and preferences are relevant-the process for reaching a recommendation should be transparent to patients and should be based solely on the medical evidence and patients' values and preferences. When patients' preferences for care do not prioritize health, physicians decide whether their recommendation will prioritize a welfare-enhancing versus an autonomy-enhancing approach. When there are gaps in understanding how physicians derive their clinical recommendations and how to further improve the quality of the decisions, the author calls for further empiric research. PMID:27045301

  3. Physician Attitudes toward Adopting Genome-Guided Prescribing through Clinical Decision Support

    Directory of Open Access Journals (Sweden)

    Casey Lynnette Overby

    2014-02-01

    Full Text Available This study assessed physician attitudes toward adopting genome-guided prescribing through clinical decision support (CDS, prior to enlisting in the Clinical Implementation of Personalized Medicine through Electronic Health Records and Genomics pilot pharmacogenomics project (CLIPMERGE PGx. We developed a survey instrument that includes the Evidence Based Practice Attitude Scale, adapted to measure attitudes toward adopting genome-informed interventions (EBPAS-GII. The survey also includes items to measure physicians’ characteristics (awareness, experience, and perceived usefulness, attitudes about personal genome testing (PGT services, and comfort using technology. We surveyed 101 General Internal Medicine physicians from the Icahn School of Medicine at Mount Sinai (ISMMS. The majority were residency program trainees (~88%. Prior to enlisting into CLIPMERGE PGx, most physicians were aware of and had used decision support aids. Few physicians, however, were aware of and had used genome-guided prescribing. The majority of physicians viewed decision support aids and genotype data as being useful for making prescribing decisions. Most physicians had not heard of, but were willing to use, PGT services and felt comfortable interpreting PGT results. Most physicians were comfortable with technology. Physicians who perceived genotype data to be useful in making prescribing decisions, had more positive attitudes toward adopting genome-guided prescribing through CDS. Our findings suggest that internal medicine physicians have a deficit in their familiarity and comfort interpreting and using genomic information. This has reinforced the importance of gathering feedback and guidance from our enrolled physicians when designing genome-guided CDS and the importance of prioritizing genomic medicine education at our institutions.

  4. Radiographer's impact on improving clinical decision-making, patient care and patient diagnosis: a pilot study

    International Nuclear Information System (INIS)

    This pilot study attempts to quantify the benefits of a documented radiographic clinical history through the use of the clinical history template form designed by Egan and Baird. Six radiographers completed the clinical history template for 40 patients and four radiologists included the recorded information as part of their reporting process. A focus discussion group was held between the radiographers to ascertain the level of satisfaction and benefits encountered with the use of the template form. A questionnaire was designed for the radiologists to complete regarding the usefulness of the template form with respect to the radiological reporting process. Results/Discussion: 15 cases for which the form was used demonstrated a direct benefit in respect to improved radiographic clinical decision-making. Radiographers agreed the template form aided the establishment of a stronger radiographer-patient relationship during the radiographic examination. Two radiologists agreed the form aided in establishing a radiological diagnosis and suggested the form be implemented as part of the standard departmental protocol. Despite the small sample size, there is evidence the form aided radiographic decision-making and assisted in the establishment of an accurate radiological diagnosis. The overall consensus amongst radiographers was that it enhanced radiographer-patient communication and improved the level of patient care. Copyright (2004) Australian Institute of Radiography

  5. Students' stereotypes of patients as barriers to clinical decision-making.

    Science.gov (United States)

    Johnson, S M; Kurtz, M E; Tomlinson, T; Howe, K R

    1986-09-01

    The ability to formulate quick, accurate clinical judgments is stressed in medical training. Speed is usually an asset when a physician sorts through his biomedical knowledge, but it is often a liability when the physician assesses the sociocultural context of a clinical encounter. At the Michigan State University College of Osteopathic Medicine, a study was designed which graphically illustrated to beginning students that unconscious sociocultural stereotypes may influence clinical decision-making. Three entering classes of students were shown a videotape depicting five simulated patients (attractive black woman, attractive white woman, professional man, middle-aged housewife, and elderly man), each presenting with the same physical complaint. Elements of positive and negative stereotypes were incorporated into each of the portrayals, and the students rated these patients on positive and negative characteristics. The results suggested that the students attributed both positive and negative characteristics to patients on the basis of irrelevant characteristics, such as attractiveness, and with little further justification for their attributions. Such stereotypic generalizations held by students may become barriers to the students' objective clinical decision-making. PMID:3755759

  6. Genetic Stratification in Myeloid Diseases: From Risk Assessment to Clinical Decision Support Tool

    Directory of Open Access Journals (Sweden)

    Yishai Ofran

    2014-10-01

    Full Text Available Genetic aberrations have become a dominant factor in the stratification of myeloid malignancies. Cytogenetic and a few mutation studies are the backbone of risk assessment models of myeloid malignancies which are a major consideration in clinical decisions, especially patient assignment for allogeneic stem cell transplantation. Progress in our understanding of the genetic basis of the pathogenesis of myeloid malignancies and the growing capabilities of mass sequencing may add new roles for the clinical usage of genetic data. A few recently identified mutations recognized to be associated with specific diseases or clinical scenarios may soon become part of the diagnostic criteria of such conditions. Mutational studies may also advance our capabilities for a more efficient patient selection process, assigning the most effective therapy at the best timing for each patient. The clinical utility of genetic data is anticipated to advance further with the adoption of deep sequencing and next-generation sequencing techniques. We herein suggest some future potential applications of sequential genetic data to identify pending deteriorations at time points which are the best for aggressive interventions such as allogeneic stem cell transplantation. Genetics is moving from being mostly a prognostic factor to becoming a multitasking decision support tool for hematologists. Physicians must pay attention to advances in molecular hematology as it will soon be accessible and influential for most of our patients.

  7. Patient exposure in the basic science classroom enhances differential diagnosis formation and clinical decision-making

    Directory of Open Access Journals (Sweden)

    Justin G. Peacock

    2015-02-01

    Full Text Available Purpose. The authors proposed that introducing real patients into a pathology classroom early in medical education would help integrate fundamental principles and disease pathology with clinical presentation and medical history. Methods. Three patients with different pathologies described their history and presentation without revealing their diagnosis. Students were required to submit a differential diagnosis in writing, and then were able to ask questions to arrive at the correct diagnosis. Students were surveyed on the efficacy of patient-based learning. Results. Average student scores on the differential diagnosis assignments significantly improved 32% during the course. From the survey, 72% of students felt that patient encounters should be included in the pathology course next year. Seventy-four percent felt that the differential diagnosis assignments helped them develop clinical decision-making skills. Seventy-three percent felt that the experience helped them know what questions to ask patients. Eighty-six percent felt that they obtained a better understanding of patients’ social and emotional challenges. Discussion. Having students work through the process of differential diagnosis formulation when encountering a real patient and their clinical presentation improved clinical decision-making skills and integrated fundamental concepts with disease pathology during a basic science pathology course.

  8. Cervical spine degenerative diseases: An evaluation of clinical and imaging features in surgical decisions

    International Nuclear Information System (INIS)

    In clinically severe cervical spondylosis, imaging plays a vital role in surgical decisions. A prime factor is acquired canal stenosis with cord compression. To validate this concept, the clinical and imaging features of 20 patients with spondylitic myelopathy and 24 with radiculopathy were retrospectively reviewed. All had computed tomographic myelography (CTM) as part of their clinical work-up. The patients' clinical severity was graded as mild, moderate and severe; the age, length of illness and a history of eventual surgery or otherwise were recorded. At the level of maximum compression the following parameters were obtained from the axial CTM images: surface area and ratio of the anteroposterior to the transverse diameter of the cord; subarachnoid space and vertebral canal areas. Data were statistically analysed. A significant association exists between surgery and increasing severity of symptoms (P=0.04), and advancing age (P=0.01). These associations hold true for myelopathy and radiculopathy. A strong association is present between surgery and the surface area of the cord (P=0.01), being applicable to myelopathy only. The other parameters show no association with surgical decisions. It is concluded that with myelopathy a narrow cord area at the level of maximum compression, and moderate-severe functional impairment are indicators for surgical intervention. (authors)

  9. Reproductive Ethics in Commercial Surrogacy: Decision-Making in IVF Clinics in New Delhi, India

    DEFF Research Database (Denmark)

    Tanderup, Malene; Reddy, Sunita; Patel, Tulsi;

    2015-01-01

    As a neo-liberal economy, India has become one of the new health tourism destinations, with Commercial gestational surrogacy as an expanding market. Yet the Indian Assisted Reproductive Technology (ART) Bill has been pending for five years, and the guidelines issued by the Indian Council of Medical...... Research are somewhat vague and contradictory, resulting in self-regulated practices of fertility clinics. This paper broadly looks at clinical ethics in reproduction in the practice of surrogacy and decision-making in various procedures. Through empirical research in New Delhi, the capital of India, from...... success rates, surrogates faced the risk of multiple pregnancy and fetal reduction with little information regarding the risks involved. In the globalized market of Commercial surrogacy in India, and with clinics compromising on ethics, there is an urgent need for formulation of regulative law for the...

  10. Clinical Decisions: Determining When to Save or Remove an Ailing Implant.

    Science.gov (United States)

    Tarnow, Dennis P; Chu, Stephen J; Fletcher, Paul D

    2016-04-01

    The basis for the decision to either save or remove an ailing implant is multifactorial, and, as such, it has become one of the more controversial topics in the field of dental implantology. While bone lost to peri-implant disease can now be augmented with increasing predictability, the degree of success still varies depending on the size and configuration of the osseous defect. Concurrently, with the development of improved high-reverse torque instrumentation, minimally invasive techniques can be used to easily remove an implant that is malpositioned, causing an esthetic problem, or showing advanced bone loss. Any eventual decision regarding the retention or removal of an ailing implant must also be balanced with the desires of the patient, who typically will have already invested significant time and money to have the implant initially placed and restored. This article will present the variables involved in the decision-making process for when to save or remove an ailing implant. Clinical examples illustrating the management for these factors will be offered, providing clinicians a variety of alternatives available for managing different clinical circumstances that may be encountered. PMID:27136118

  11. Cancer Multidisciplinary Team Meetings: Evidence, Challenges, and the Role of Clinical Decision Support Technology

    International Nuclear Information System (INIS)

    Multidisciplinary team (MDT) model in cancer care was introduced and endorsed to ensure that care delivery is consistent with the best available evidence. Over the last few years, regular MDT meetings have become a standard practice in oncology and gained the status of the key decision-making forum for patient management. Despite the fact that cancer MDT meetings are well accepted by clinicians, concerns are raised over the paucity of good-quality evidence on their overall impact. There are also concerns over lack of the appropriate support for this important but overburdened decision-making platform. The growing acceptance by clinical community of the health information technology in recent years has created new opportunities and possibilities of using advanced clinical decision support (CDS) systems to realise full potential of cancer MDT meetings. In this paper, we present targeted summary of the available evidence on the impact of cancer MDT meetings, discuss the reported challenges, and explore the role that a CDS technology could play in addressing some of these challenges

  12. [Human body meridian spatial decision support system for clinical treatment and teaching of acupuncture and moxibustion].

    Science.gov (United States)

    Wu, Dehua

    2016-01-01

    The spatial position and distribution of human body meridian are expressed limitedly in the decision support system (DSS) of acupuncture and moxibustion at present, which leads to the failure to give the effective quantitative analysis on the spatial range and the difficulty for the decision-maker to provide a realistic spatial decision environment. Focusing on the limit spatial expression in DSS of acupuncture and moxibustion, it was proposed that on the basis of the geographic information system, in association of DSS technology, the design idea was developed on the human body meridian spatial DSS. With the 4-layer service-oriented architecture adopted, the data center integrated development platform was taken as the system development environment. The hierarchical organization was done for the spatial data of human body meridian via the directory tree. The structured query language (SQL) server was used to achieve the unified management of spatial data and attribute data. The technologies of architecture, configuration and plug-in development model were integrated to achieve the data inquiry, buffer analysis and program evaluation of the human body meridian spatial DSS. The research results show that the human body meridian spatial DSS could reflect realistically the spatial characteristics of the spatial position and distribution of human body meridian and met the constantly changeable demand of users. It has the powerful spatial analysis function and assists with the scientific decision in clinical treatment and teaching of acupuncture and moxibustion. It is the new attempt to the informatization research of human body meridian. PMID:26946752

  13. Computerized clinical decision support systems for therapeutic drug monitoring and dosing: A decision-maker-researcher partnership systematic review

    Directory of Open Access Journals (Sweden)

    Weise-Kelly Lorraine

    2011-08-01

    Full Text Available Abstract Background Some drugs have a narrow therapeutic range and require monitoring and dose adjustments to optimize their efficacy and safety. Computerized clinical decision support systems (CCDSSs may improve the net benefit of these drugs. The objective of this review was to determine if CCDSSs improve processes of care or patient outcomes for therapeutic drug monitoring and dosing. Methods We conducted a decision-maker-researcher partnership systematic review. Studies from our previous review were included, and new studies were sought until January 2010 in MEDLINE, EMBASE, Evidence-Based Medicine Reviews, and Inspec databases. Randomized controlled trials assessing the effect of a CCDSS on process of care or patient outcomes were selected by pairs of independent reviewers. A study was considered to have a positive effect (i.e., CCDSS showed improvement if at least 50% of the relevant study outcomes were statistically significantly positive. Results Thirty-three randomized controlled trials were identified, assessing the effect of a CCDSS on management of vitamin K antagonists (14, insulin (6, theophylline/aminophylline (4, aminoglycosides (3, digoxin (2, lidocaine (1, or as part of a multifaceted approach (3. Cluster randomization was rarely used (18% and CCDSSs were usually stand-alone systems (76% primarily used by physicians (85%. Overall, 18 of 30 studies (60% showed an improvement in the process of care and 4 of 19 (21% an improvement in patient outcomes. All evaluable studies assessing insulin dosing for glycaemic control showed an improvement. In meta-analysis, CCDSSs for vitamin K antagonist dosing significantly improved time in therapeutic range. Conclusions CCDSSs have potential for improving process of care for therapeutic drug monitoring and dosing, specifically insulin and vitamin K antagonist dosing. However, studies were small and generally of modest quality, and effects on patient outcomes were uncertain, with no convincing

  14. Decision Making in the PICU: An Examination of Factors Influencing Participation Decisions in Phase III Randomized Clinical Trials

    OpenAIRE

    Slosky, Laura E; Marilyn Stern; Burke, Natasha L.; Siminoff, Laura A.

    2014-01-01

    Background. In stressful situations, decision making processes related to informed consent may be compromised. Given the profound levels of distress that surrogates of children in pediatric intensive care units (PICU) experience, it is important to understand what factors may be influencing the decision making process beyond the informed consent. The purpose of this study was to evaluate the role of clinician influence and other factors on decision making regarding participation in a randomiz...

  15. A Critical Review of the Theoretical Frameworks and the Conceptual Factors in the Adoption of Clinical Decision Support Systems.

    Science.gov (United States)

    Khong, Peck Chui Betty; Holroyd, Eleanor; Wang, Wenru

    2015-12-01

    The clinical decision support system is utilized to translate knowledge into evidence-based practice in clinical settings. Many studies have been conducted to understand users' adoption of the clinical decision support system. A critical review was conducted to understand the theoretical or conceptual frameworks used to inform the studies on the adoption of the clinical decision support system. The review identified 15 theoretical and conceptual frameworks using multiple hybrids of theories and concepts. The Technology Acceptance Model was the most frequently used baseline framework combined with frameworks such as the diffusion of innovation, social theory, longitudinal theory, and so on. The results from these articles yielded multiple concepts influencing the adoption of the clinical decision support system. These concepts can be recategorized into nine major concepts, namely, the information system, person (user or patient), social, organization, perceived benefits, emotions, trustability, relevance (fitness), and professionalism. None of the studies found all the nine concepts. That said, most of them have identified the information system, organization, and person concepts as three of its concepts affecting the use of the clinical decision support system. Within each of the concepts, its subconcepts were noted to be very varied. Yet each of these subconcepts has significantly contributed toward the different facets of the concepts. A pluralistic framework was built using the concepts and subconcepts to provide an overall framework construct for future study on the adoption of the clinical decision support system. PMID:26535769

  16. A study of diverse clinical decision support rule authoring environments and requirements for integration

    Directory of Open Access Journals (Sweden)

    Zhou Li

    2012-11-01

    Full Text Available Abstract Background Efficient rule authoring tools are critical to allow clinical Knowledge Engineers (KEs, Software Engineers (SEs, and Subject Matter Experts (SMEs to convert medical knowledge into machine executable clinical decision support rules. The goal of this analysis was to identify the critical success factors and challenges of a fully functioning Rule Authoring Environment (RAE in order to define requirements for a scalable, comprehensive tool to manage enterprise level rules. Methods The authors evaluated RAEs in active use across Partners Healthcare, including enterprise wide, ambulatory only, and system specific tools, with a focus on rule editors for reminder and medication rules. We conducted meetings with users of these RAEs to discuss their general experience and perceived advantages and limitations of these tools. Results While the overall rule authoring process is similar across the 10 separate RAEs, the system capabilities and architecture vary widely. Most current RAEs limit the ability of the clinical decision support (CDS interventions to be standardized, sharable, interoperable, and extensible. No existing system meets all requirements defined by knowledge management users. Conclusions A successful, scalable, integrated rule authoring environment will need to support a number of key requirements and functions in the areas of knowledge representation, metadata, terminology, authoring collaboration, user interface, integration with electronic health record (EHR systems, testing, and reporting.

  17. An Engineered Approach to Stem Cell Culture: Automating the Decision Process for Real-Time Adaptive Subculture of Stem Cells

    OpenAIRE

    Ker, Dai Fei Elmer; Weiss, Lee E.; Junkers, Silvina N.; Chen, Mei; Yin, Zhaozheng; Sandbothe, Michael F.; Huh, Seung-il; Eom, Sungeun; Bise, Ryoma; Osuna-Highley, Elvira; Kanade, Takeo; Campbell, Phil G.

    2011-01-01

    Current cell culture practices are dependent upon human operators and remain laborious and highly subjective, resulting in large variations and inconsistent outcomes, especially when using visual assessments of cell confluency to determine the appropriate time to subculture cells. Although efforts to automate cell culture with robotic systems are underway, the majority of such systems still require human intervention to determine when to subculture. Thus, it is necessary to accurately and obj...

  18. Implementation of an Automated Respiratory Amplitude Gating Technique for PET/CT: Clinical Evaluation

    OpenAIRE

    Chang, Guoping; Chang, Tingting; Pan, Tinsu; Clark, John W.; Mawlawi, Osama R.

    2009-01-01

    Amplitude gating techniques have recently been shown to be better at suppressing respiratory motion artifacts than phase gating. However, most commercial PET/CT scanners are equipped with phase gating capabilities only. The objective of this article was to propose and evaluate using patient studies an automated respiratory amplitude gating technique that could be implemented on current whole-body PET/CT scanners. A primary design feature of the proposed technique is to automatically match the...

  19. A diagnosis-based clinical decision rule for spinal pain part 2: review of the literature

    Directory of Open Access Journals (Sweden)

    Hurwitz Eric L

    2008-08-01

    Full Text Available Abstract Background Spinal pain is a common and often disabling problem. The research on various treatments for spinal pain has, for the most part, suggested that while several interventions have demonstrated mild to moderate short-term benefit, no single treatment has a major impact on either pain or disability. There is great need for more accurate diagnosis in patients with spinal pain. In a previous paper, the theoretical model of a diagnosis-based clinical decision rule was presented. The approach is designed to provide the clinician with a strategy for arriving at a specific working diagnosis from which treatment decisions can be made. It is based on three questions of diagnosis. In the current paper, the literature on the reliability and validity of the assessment procedures that are included in the diagnosis-based clinical decision rule is presented. Methods The databases of Medline, Cinahl, Embase and MANTIS were searched for studies that evaluated the reliability and validity of clinic-based diagnostic procedures for patients with spinal pain that have relevance for questions 2 (which investigates characteristics of the pain source and 3 (which investigates perpetuating factors of the pain experience. In addition, the reference list of identified papers and authors' libraries were searched. Results A total of 1769 articles were retrieved, of which 138 were deemed relevant. Fifty-one studies related to reliability and 76 related to validity. One study evaluated both reliability and validity. Conclusion Regarding some aspects of the DBCDR, there are a number of studies that allow the clinician to have a reasonable degree of confidence in his or her findings. This is particularly true for centralization signs, neurodynamic signs and psychological perpetuating factors. There are other aspects of the DBCDR in which a lesser degree of confidence is warranted, and in which further research is needed.

  20. Patient involvement in decision-making: a cross-sectional study in a Malaysian primary care clinic

    OpenAIRE

    Ambigapathy, Ranjini; Chia, Yook Chin; Ng, Chirk Jenn

    2016-01-01

    Objective Shared decision-making has been advocated as a useful model for patient management. In developing Asian countries such as Malaysia, there is a common belief that patients prefer a passive role in clinical consultation. As such, the objective of this study was to determine Malaysian patients’ role preference in decision-making and the associated factors. Design A cross-sectional study. Setting Study was conducted at an urban primary care clinic in Malaysia in 2012. Participants Patie...

  1. Clinical decision making and outcome in the routine care of people with severe mental illness across Europe (CEDAR)

    OpenAIRE

    Puschner, B; Becker, T.; Mayer, B; Jordan, H.; Maj, M.; Fiorillo, A; Égerházi, A.; Ivánka, T.; Munk-Jørgensen, P; Krogsgaard Bording, M.; Rössler, W.; Kawohl, W; Slade, Mike

    2016-01-01

    Aims. There is a lack of knowledge on clinical decision making and its relation to outcome in the routine treatment of people with severe mental illness. This study examined preferred and experienced clinical decision making from the perspectives of patients and staff, and how these affect treatment outcome. Methods. CEDAR (ISRCTN75841675) is a naturalistic prospective observational study with bimonthly assessments during a 12-month observation period. 588 adults with severe mental illnes...

  2. Automated development of artificial neural networks for clinical purposes: Application for predicting the outcome of choledocholithiasis surgery.

    Science.gov (United States)

    Vukicevic, Arso M; Stojadinovic, Miroslav; Radovic, Milos; Djordjevic, Milena; Cirkovic, Bojana Andjelkovic; Pejovic, Tomislav; Jovicic, Gordana; Filipovic, Nenad

    2016-08-01

    Among various expert systems (ES), Artificial Neural Network (ANN) has shown to be suitable for the diagnosis of concurrent common bile duct stones (CBDS) in patients undergoing elective cholecystectomy. However, their application in practice remains limited since the development of ANNs represents a slow process that requires additional expertize from potential users. The aim of this study was to propose an ES for automated development of ANNs and validate its performances on the problem of prediction of CBDS. Automated development of the ANN was achieved by applying the evolutionary assembling approach, which assumes optimal configuring of the ANN parameters by using Genetic algorithm. Automated selection of optimal features for the ANN training was performed using a Backward sequential feature selection algorithm. The assessment of the developed ANN included the evaluation of predictive ability and clinical utility. For these purposes, we collected data from 303 patients who underwent surgery in the period from 2008 to 2014. The results showed that the total bilirubin, alanine aminotransferase, common bile duct diameter, number of stones, size of the smallest calculus, biliary colic, acute cholecystitis and pancreatitis had the best prognostic value of CBDS. Compared to the alternative approaches, the ANN obtained by the proposed ES had better sensitivity and clinical utility, which are considered to be the most important for the particular problem. Besides the fact that it enabled the development of ANNs with better performances, the proposed ES significantly reduced the complexity of ANNs' development compared to previous studies that required manual selection of optimal features and/or ANN configuration. Therefore, it is concluded that the proposed ES represents a robust and user-friendly framework that, apart from the prediction of CBDS, could advance and simplify the application of ANNs for solving a wider range of problems. PMID:27261565

  3. Clinical Decision Support Tools for Selecting Interventions for Patients with Disabling Musculoskeletal Disorders

    DEFF Research Database (Denmark)

    Gross, Douglas P; Armijo-Olivo, Susan; Shaw, William S; Williams-Whitt, Kelly; Shaw, Nicola T; Hartvigsen, Jan; Qin, Ziling; Ha, Christine; Woodhouse, Linda J; Steenstra, Ivan A

    2016-01-01

    Purpose We aimed to identify and inventory clinical decision support (CDS) tools for helping front-line staff select interventions for patients with musculoskeletal (MSK) disorders. Methods We used Arksey and O'Malley's scoping review framework which progresses through five stages: (1) identifying...... the research question; (2) identifying relevant studies; (3) selecting studies for analysis; (4) charting the data; and (5) collating, summarizing and reporting results. We considered computer-based, and other available tools, such as algorithms, care pathways, rules and models. Since this research...

  4. Clinical decision support, systems methodology, and telemedicine: their role in the management of chronic disease.

    Science.gov (United States)

    Carson, E R; Cramp, D G; Morgan, A; Roudsari, A V

    1998-06-01

    In this paper, the design and evaluation of decision support systems, including those incorporating a telematic component, are considered. It is argued that effective design and evaluation are dependent upon the adoption of appropriate methodology set firmly within a systemic framework. Systems modeling is proposed as an approach to system design, with evaluation adopting an approach incorporating evaluability analysis and formative and summative evaluation, including the use of stakeholder matrix analysis. The relevance of such systemic methodology is demonstrated in the context of diabetes and end-stage renal disease as examples of the generic clinical problem of the management of chronic disease. PMID:10719517

  5. Performance of online drug information databases as clinical decision support tools in infectious disease medication management.

    Science.gov (United States)

    Polen, Hyla H; Zapantis, Antonia; Clauson, Kevin A; Clauson, Kevin Alan; Jebrock, Jennifer; Paris, Mark

    2008-01-01

    Infectious disease (ID) medication management is complex and clinical decision support tools (CDSTs) can provide valuable assistance. This study evaluated scope and completeness of ID drug information found in online databases by evaluating their ability to answer 147 question/answer pairs. Scope scores produced highest rankings (%) for: Micromedex (82.3), Lexi-Comp/American Hospital Formulary Service (81.0), and Medscape Drug Reference (81.0); lowest includes: Epocrates Online Premium (47.0), Johns Hopkins ABX Guide (45.6), and PEPID PDC (40.8). PMID:18999059

  6. Recurrent Neural Networks in Computer-Based Clinical Decision Support for Laryngopathies: An Experimental Study

    OpenAIRE

    Jan Warchoł; Jarosław Szkoła; Krzysztof Pancerz

    2011-01-01

    The main goal of this paper is to give the basis for creating a computer-based clinical decision support (CDS) system for laryngopathies. One of approaches which can be used in the proposed CDS is based on the speech signal analysis using recurrent neural networks (RNNs). RNNs can be used for pattern recognition in time series data due to their ability of memorizing some information from the past. The Elman networks (ENs) are a classical representative of RNNs. To improve learning ability of ...

  7. Clinical decision making in response to performance validity test failure in a psychiatric setting.

    Science.gov (United States)

    Marcopulos, Bernice A; Caillouet, Beth A; Bailey, Christopher M; Tussey, Chriscelyn; Kent, Julie-Ann; Frederick, Richard

    2014-01-01

    This study examined the clinical utility of a performance validity test (PVT) for screening consecutive referrals (N = 436) to a neuropsychology service at a state psychiatric hospital treating both civilly committed and forensic patients. We created a contingency table with Test of Memory Malingering (TOMM) pass/fail (355/81) and secondary gain present/absent (181/255) to examine pass rates associated with patient demographic, clinical and forensic status characteristics. Of the 81 failed PVTs, 48 had secondary gain defined as active criminal legal charges; 33 failed PVTs with no secondary gain. These individuals tended to be older, female, Caucasian, and civilly committed compared with the group with secondary gain who failed. From estimations of TOMM False Positive Rate and True Positive Rate we estimated base rates of neurocognitive malingering for our clinical population using the Test Validation Summary (TVS; Frederick & Bowden, 2009 ). Although PVT failure is clearly more common in a group with secondary gain (31%), there were a number of false positives (11%). Clinical ratings of patients without gain who failed suggested cognitive deficits, behavioral issues, and inattention. Low scores on PVTs in the absence of secondary gain provide useful information on test engagement and can inform clinical decisions about testing. PMID:24678658

  8. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: Methods of a decision-maker-researcher partnership systematic review

    Directory of Open Access Journals (Sweden)

    Wilczynski Nancy L

    2010-02-01

    Full Text Available Abstract Background Computerized clinical decision support systems are information technology-based systems designed to improve clinical decision-making. As with any healthcare intervention with claims to improve process of care or patient outcomes, decision support systems should be rigorously evaluated before widespread dissemination into clinical practice. Engaging healthcare providers and managers in the review process may facilitate knowledge translation and uptake. The objective of this research was to form a partnership of healthcare providers, managers, and researchers to review randomized controlled trials assessing the effects of computerized decision support for six clinical application areas: primary preventive care, therapeutic drug monitoring and dosing, drug prescribing, chronic disease management, diagnostic test ordering and interpretation, and acute care management; and to identify study characteristics that predict benefit. Methods The review was undertaken by the Health Information Research Unit, McMaster University, in partnership with Hamilton Health Sciences, the Hamilton, Niagara, Haldimand, and Brant Local Health Integration Network, and pertinent healthcare service teams. Following agreement on information needs and interests with decision-makers, our earlier systematic review was updated by searching Medline, EMBASE, EBM Review databases, and Inspec, and reviewing reference lists through 6 January 2010. Data extraction items were expanded according to input from decision-makers. Authors of primary studies were contacted to confirm data and to provide additional information. Eligible trials were organized according to clinical area of application. We included randomized controlled trials that evaluated the effect on practitioner performance or patient outcomes of patient care provided with a computerized clinical decision support system compared with patient care without such a system. Results Data will be summarized

  9. Ethics of Clinical Decision-Making for Older Drivers: Reporting Health-Related Driving Risk.

    Science.gov (United States)

    Mazer, Barbara; Laliberté, Maude; Hunt, Matthew; Lemoignan, Josée; Gélinas, Isabelle; Vrkljan, Brenda; Naglie, Gary; Marshall, Shawn

    2016-06-01

    The number of older drivers will continue to increase as the population ages. Health care professionals have the responsibility of providing care and maintaining confidentiality for their patients while ensuring public safety. This article discusses the ethics of clinical decision-making pertaining to reporting health-related driving risk of older drivers to licensing authorities. Ethical considerations inherent in reporting driving risk, including autonomy, confidentiality, therapeutic relationships, and the uncertainty about determining individual driving safety and risk, are discussed. We also address the moral agency of reporting health-related driving risk and raise the question of whose responsibility it is to report. Issues of uncertainty surrounding clinical reasoning and concepts related to risk assessment are also discussed. Finally, we present two case studies to illustrate some of the issues and challenges faced by health care professionals as they seek to balance their responsibilities for their patients while ensuring road safety for all citizens. PMID:27117942

  10. Multidisciplinary Modelling of Symptoms and Signs with Archetypes and SNOMED-CT for Clinical Decision Support.

    Science.gov (United States)

    Marco-Ruiz, Luis; Maldonado, J Alberto; Karlsen, Randi; Bellika, Johan G

    2015-01-01

    Clinical Decision Support Systems (CDSS) help to improve health care and reduce costs. However, the lack of knowledge management and modelling hampers their maintenance and reuse. Current EHR standards and terminologies can allow the semantic representation of the data and knowledge of CDSS systems boosting their interoperability, reuse and maintenance. This paper presents the modelling process of respiratory conditions' symptoms and signs by a multidisciplinary team of clinicians and information architects with the help of openEHR, SNOMED and clinical information modelling tools for a CDSS. The information model of the CDSS was defined by means of an archetype and the knowledge model was implemented by means of an SNOMED-CT based ontology. PMID:25991115

  11. [Automated decision making support system for urologists on the prediction and the prevention of stone formation in urolithiasis].

    Science.gov (United States)

    Kotsar', A G; Seregin, S P; Novikov, A V

    2013-01-01

    This article describes a decision making support system for urologists on the prediction and management of preventive interventions for urolithiasis using fuzzy logic decision-making device. Dictionary of informative signs and alphabet of classes are formed. The formulas for calculating the membership functions according to the known features are developed; these formulas allow to calculate the certainty factors for pertaining of inspected object to the desired class by means of iterative rules of rule of logical inference. Based on comparison of the values obtained with the threshold certainty factors, dephasification of conclusion is produced. In accordance with the obtained decision rules, control algorithm for the prevention measures in urolithiasis is developed. To test the effectiveness of "operation" of the synthesized decision rules, the certainty factors were calculated or 200 patients with urolithiasis, which were divided into two groups according to the results of observation during the year depending on the presence of recurrence. The analysis of the intersection of histograms of distribution of coefficient values showed high diagnostic efficiency (0.94) of synthesized decision rules. PMID:24437234

  12. Which factors play a role in clinical decision-making in subfertility?

    Science.gov (United States)

    van der Steeg, Jan W; Steures, Pieternel; Eijkemans, Marinus J C; Habbema, J Dik F; Bossuyt, Patrick M M; Hompes, Peter G A; van der Veen, Fulco; Mol, Ben W J

    2006-04-01

    Sixteen vignettes of subfertile couples were constructed by varying fertility history, post-coital test, sperm motility, FSH concentration and Chlamydia antibody titre (CAT). Thirty-five gynaecologists estimated probabilities of treatment-independent pregnancy, intrauterine insemination (IUI) and IVF. Thereafter, they chose IUI, IVF or no treatment. The relative contribution of each factor to probability estimates and to subsequent treatment decisions was calculated. Duration of subfertility and maternal age were the most important contributors for gynaecologists' estimates of treatment-independent pregnancy [relative contribution (RC) 41, 26%]. Maternal age and FSH concentration were the most important contributors in the estimates for IUI (RC: 51, 25%) and for IVF (RC: 64, 31%). The decision to start IVF was mainly determined by maternal age, duration of subfertility, FSH concentration and CAT. The relative contribution of maternal age and duration of subfertility was in concordance with existing prediction models, whereas previous pregnancy and FSH concentration were under- and overestimated respectively. In conclusion, maternal age, duration of subfertility and FSH concentration are the main factors in clinical decision-making in subfertility. Gynaecologists overestimate the importance of FSH concentration, but underestimate that of a previous pregnancy, as compared with their importance reported in prediction models and guidelines. PMID:16740221

  13. Application of a diagnosis-based clinical decision guide in patients with low back pain

    Directory of Open Access Journals (Sweden)

    Murphy Donald R

    2011-10-01

    Full Text Available Abstract Background Low back pain (LBP is common and costly. Development of accurate and efficacious methods of diagnosis and treatment has been identified as a research priority. A diagnosis-based clinical decision guide (DBCDG; previously referred to as a diagnosis-based clinical decision rule has been proposed which attempts to provide the clinician with a systematic, evidence-based means to apply the biopsychosocial model of care. The approach is based on three questions of diagnosis. The purpose of this study is to present the prevalence of findings using the DBCDG in consecutive patients with LBP. Methods Demographic, diagnostic and baseline outcome measure data were gathered on a cohort of LBP patients examined by one of three examiners trained in the application of the DBCDG. Results Data were gathered on 264 patients. Signs of visceral disease or potentially serious illness were found in 2.7%. Centralization signs were found in 41%, lumbar and sacroiliac segmental signs in 23% and 27%, respectively and radicular signs were found in 24%. Clinically relevant myofascial signs were diagnosed in 10%. Dynamic instability was diagnosed in 63%, fear beliefs in 40%, central pain hypersensitivity in 5%, passive coping in 3% and depression in 3%. Conclusion The DBCDG can be applied in a busy private practice environment. Further studies are needed to investigate clinically relevant means to identify central pain hypersensitivity, poor coping and depression, correlations and patterns among the diagnostic components of the DBCDG as well as inter-examiner reliability and efficacy of treatment based on the DBCDG.

  14. Application of a diagnosis-based clinical decision guide in patients with neck pain

    Directory of Open Access Journals (Sweden)

    Murphy Donald R

    2011-08-01

    Full Text Available Abstract Background Neck pain (NP is a common cause of disability. Accurate and efficacious methods of diagnosis and treatment have been elusive. A diagnosis-based clinical decision guide (DBCDG; previously referred to as a diagnosis-based clinical decision rule has been proposed which attempts to provide the clinician with a systematic, evidence-based guide in applying the biopsychosocial model of care. The approach is based on three questions of diagnosis. The purpose of this study is to present the prevalence of findings using the DBCDG in consecutive patients with NP. Methods Demographic, diagnostic and baseline outcome measure data were gathered on a cohort of NP patients examined by one of three examiners trained in the application of the DBCDG. Results Data were gathered on 95 patients. Signs of visceral disease or potentially serious illness were found in 1%. Centralization signs were found in 27%, segmental pain provocation signs were found in 69% and radicular signs were found in 19%. Clinically relevant myofascial signs were found in 22%. Dynamic instability was found in 40%, oculomotor dysfunction in 11.6%, fear beliefs in 31.6%, central pain hypersensitivity in 4%, passive coping in 5% and depression in 2%. Conclusion The DBCDG can be applied in a busy private practice environment. Further studies are needed to investigate clinically relevant means to identify central pain hypersensitivity, oculomotor dysfunction, poor coping and depression, correlations and patterns among the diagnostic components of the DBCDG as well as inter-examiner reliability, validity and efficacy of treatment based on the DBCDG.

  15. Automated Methods to Extract Patient New Information from Clinical Notes in Electronic Health Record Systems

    Science.gov (United States)

    Zhang, Rui

    2013-01-01

    The widespread adoption of Electronic Health Record (EHR) has resulted in rapid text proliferation within clinical care. Clinicians' use of copying and pasting functions in EHR systems further compounds this by creating a large amount of redundant clinical information in clinical documents. A mixture of redundant information (especially outdated…

  16. Clinical decision making and outcome in the routine care of people with severe mental illness across Europe (CEDAR)

    DEFF Research Database (Denmark)

    Puschner, B; Becker, T; Mayer, B;

    2016-01-01

    course over time in involvement in and satisfaction with actual decision making. The effect of clinical decision making on the primary outcome was examined using hierarchical linear modelling controlling for covariates (study centre, patient age, duration of illness, and diagnosis). Analysis were also...... controlled for nesting of patients within staff. Results. Of 708 individuals approached, 588 adults with severe mental illness (52% female, mean age = 41.7) gave informed consent. Paired staff participants (N = 213) were 61.8% female and 46.0 years old on average. Shared decision making was preferred by......Aims. Shared decision making has been advocated as a means to improve patient-orientation and quality of health care. There is a lack of knowledge on clinical decision making and its relation to outcome in the routine treatment of people with severe mental illness. This study examined preferred and...

  17. Automated integration of wireless biosignal collection devices for patient-centred decision-making in point-of-care systems.

    Science.gov (United States)

    Menychtas, Andreas; Tsanakas, Panayiotis; Maglogiannis, Ilias

    2016-03-01

    The proper acquisition of biosignals data from various biosensor devices and their remote accessibility are still issues that prevent the wide adoption of point-of-care systems in the routine of monitoring chronic patients. This Letter presents an advanced framework for enabling patient monitoring that utilises a cloud computing infrastructure for data management and analysis. The framework introduces also a local mechanism for uniform biosignals collection from wearables and biosignal sensors, and decision support modules, in order to enable prompt and essential decisions. A prototype smartphone application and the related cloud modules have been implemented for demonstrating the value of the proposed framework. Initial results regarding the performance of the system and the effectiveness in data management and decision-making have been quite encouraging. PMID:27222731

  18. An engineered approach to stem cell culture: automating the decision process for real-time adaptive subculture of stem cells.

    Directory of Open Access Journals (Sweden)

    Dai Fei Elmer Ker

    Full Text Available Current cell culture practices are dependent upon human operators and remain laborious and highly subjective, resulting in large variations and inconsistent outcomes, especially when using visual assessments of cell confluency to determine the appropriate time to subculture cells. Although efforts to automate cell culture with robotic systems are underway, the majority of such systems still require human intervention to determine when to subculture. Thus, it is necessary to accurately and objectively determine the appropriate time for cell passaging. Optimal stem cell culturing that maintains cell pluripotency while maximizing cell yields will be especially important for efficient, cost-effective stem cell-based therapies. Toward this goal we developed a real-time computer vision-based system that monitors the degree of cell confluency with a precision of 0.791±0.031 and recall of 0.559±0.043. The system consists of an automated phase-contrast time-lapse microscope and a server. Multiple dishes are sequentially imaged and the data is uploaded to the server that performs computer vision processing, predicts when cells will exceed a pre-defined threshold for optimal cell confluency, and provides a Web-based interface for remote cell culture monitoring. Human operators are also notified via text messaging and e-mail 4 hours prior to reaching this threshold and immediately upon reaching this threshold. This system was successfully used to direct the expansion of a paradigm stem cell population, C2C12 cells. Computer-directed and human-directed control subcultures required 3 serial cultures to achieve the theoretical target cell yield of 50 million C2C12 cells and showed no difference for myogenic and osteogenic differentiation. This automated vision-based system has potential as a tool toward adaptive real-time control of subculturing, cell culture optimization and quality assurance/quality control, and it could be integrated with current and

  19. Paying for treatments? Influences on negotiating clinical need and decision-making for dental implant treatment

    Directory of Open Access Journals (Sweden)

    Thomason J Mark

    2009-01-01

    Full Text Available Abstract Background The aim of this study is to examine how clinicians and patients negotiate clinical need and treatment decisions within a context of finite resources. Dental implant treatment is an effective treatment for missing teeth, but is only available via the NHS in some specific clinical circumstances. The majority of people who receive this treatment therefore pay privately, often at substantial cost to themselves. People are used to paying towards dental treatment costs. However, dental implant treatment is much more expensive than existing treatments – such as removable dentures. We know very little about how dentists make decisions about whether to offer such treatments, or what patients consider when deciding whether or not to pay for them. Methods/Design Mixed methods will be employed to provide insight and understanding into how clinical need is determined, and what influences people's decision making processes when deciding whether or not to pursue a dental implant treatment. Phase 1 will use a structured scoping questionnaire with all the General dental practitioners (GDPs in three Primary Care Trust areas (n = 300 to provide base-line data about existing practice in relation to dental implant treatment, and to provide data to develop a systematic sampling procedure for Phase 2. Phases 2 (GDPs and 3 (patients use qualitative focused one to one interviews with a sample of these practitioners (up to 30 and their patients (up to 60 to examine their views and experiences of decision making in relation to dental implant treatment. Purposive sampling for phases 2 and 3 will be carried out to ensure participants represent a range of socio-economic circumstances, and choices made. Discussion Most dental implant treatment is conducted in primary care. Very little information was available prior to this study about the quantity and type of treatment carried out privately. It became apparent during phase 2 that ISOD treatment was an

  20. Functional Assessment of Genetic Variants with Outcomes Adapted to Clinical Decision-Making.

    Science.gov (United States)

    Thouvenot, Pierre; Ben Yamin, Barbara; Fourrière, Lou; Lescure, Aurianne; Boudier, Thomas; Del Nery, Elaine; Chauchereau, Anne; Goldgar, David E; Houdayer, Claude; Stoppa-Lyonnet, Dominique; Nicolas, Alain; Millot, Gaël A

    2016-06-01

    Understanding the medical effect of an ever-growing number of human variants detected is a long term challenge in genetic counseling. Functional assays, based on in vitro or in vivo evaluations of the variant effects, provide essential information, but they require robust statistical validation, as well as adapted outputs, to be implemented in the clinical decision-making process. Here, we assessed 25 pathogenic and 15 neutral missense variants of the BRCA1 breast/ovarian cancer susceptibility gene in four BRCA1 functional assays. Next, we developed a novel approach that refines the variant ranking in these functional assays. Lastly, we developed a computational system that provides a probabilistic classification of variants, adapted to clinical interpretation. Using this system, the best functional assay exhibits a variant classification accuracy estimated at 93%. Additional theoretical simulations highlight the benefit of this ready-to-use system in the classification of variants after functional assessment, which should facilitate the consideration of functional evidences in the decision-making process after genetic testing. Finally, we demonstrate the versatility of the system with the classification of siRNAs tested for human cell growth inhibition in high throughput screening. PMID:27272900

  1. Functional Assessment of Genetic Variants with Outcomes Adapted to Clinical Decision-Making.

    Directory of Open Access Journals (Sweden)

    Pierre Thouvenot

    2016-06-01

    Full Text Available Understanding the medical effect of an ever-growing number of human variants detected is a long term challenge in genetic counseling. Functional assays, based on in vitro or in vivo evaluations of the variant effects, provide essential information, but they require robust statistical validation, as well as adapted outputs, to be implemented in the clinical decision-making process. Here, we assessed 25 pathogenic and 15 neutral missense variants of the BRCA1 breast/ovarian cancer susceptibility gene in four BRCA1 functional assays. Next, we developed a novel approach that refines the variant ranking in these functional assays. Lastly, we developed a computational system that provides a probabilistic classification of variants, adapted to clinical interpretation. Using this system, the best functional assay exhibits a variant classification accuracy estimated at 93%. Additional theoretical simulations highlight the benefit of this ready-to-use system in the classification of variants after functional assessment, which should facilitate the consideration of functional evidences in the decision-making process after genetic testing. Finally, we demonstrate the versatility of the system with the classification of siRNAs tested for human cell growth inhibition in high throughput screening.

  2. Evaluation of Clinical Decision Rules for Bone Mineral Density Testing among White Women

    Directory of Open Access Journals (Sweden)

    Michael E. Anders

    2013-01-01

    Full Text Available Background. Osteoporosis is a devastating, insidious disease that causes skeletal fragility. Half of women will suffer osteoporotic fractures during their lifetimes. Many fractures occur needlessly, because of inattentiveness to assessment, diagnosis, prevention, and treatment of osteoporosis. Study Purpose. Study Purpose. To evaluate the discriminatory performance of clinical decision rules to determine the need to undergo bone mineral density testing. Methods. A nationally representative sample from the Third National Health and Nutrition Examination Survey consisted of 14,060 subjects who completed surveys, physical examinations, laboratory tests, and bone mineral density exams. Multivariable linear regression tested the correlation of covariates that composed the clinical decision rules with bone mineral density. Results. Increased age and decreased weight were variables in the final regression models for each gender and race/ethnicity. Among the indices, the Osteoporosis Self-Assessment Tool, which is composed of age and weight, performed best for White women. Study Implications. These results have implications for the prevention, assessment, diagnosis, and treatment of osteoporosis. The Osteoporosis Self-Assessment Tool performed best and is inexpensive and the least time consuming to implement.

  3. Functional Assessment of Genetic Variants with Outcomes Adapted to Clinical Decision-Making

    Science.gov (United States)

    Thouvenot, Pierre; Ben Yamin, Barbara; Fourrière, Lou; Lescure, Aurianne; Boudier, Thomas; Del Nery, Elaine; Chauchereau, Anne; Goldgar, David E.; Stoppa-Lyonnet, Dominique; Nicolas, Alain; Millot, Gaël A.

    2016-01-01

    Understanding the medical effect of an ever-growing number of human variants detected is a long term challenge in genetic counseling. Functional assays, based on in vitro or in vivo evaluations of the variant effects, provide essential information, but they require robust statistical validation, as well as adapted outputs, to be implemented in the clinical decision-making process. Here, we assessed 25 pathogenic and 15 neutral missense variants of the BRCA1 breast/ovarian cancer susceptibility gene in four BRCA1 functional assays. Next, we developed a novel approach that refines the variant ranking in these functional assays. Lastly, we developed a computational system that provides a probabilistic classification of variants, adapted to clinical interpretation. Using this system, the best functional assay exhibits a variant classification accuracy estimated at 93%. Additional theoretical simulations highlight the benefit of this ready-to-use system in the classification of variants after functional assessment, which should facilitate the consideration of functional evidences in the decision-making process after genetic testing. Finally, we demonstrate the versatility of the system with the classification of siRNAs tested for human cell growth inhibition in high throughput screening. PMID:27272900

  4. Design and implementation of a decision support system for breast cancer treatment based on clinical practice guidelines

    International Nuclear Information System (INIS)

    Evidence based medicine is the clinical practice that uses medical data and proof in order to make efficient clinical decisions. Information technology (IT) can play a crucial role in exploiting the huge size of raw medical data involved. In an attempt to improve clinical efficacy, health care society nowadays also utilizes a new assistant, clinical guidelines. Our research concerns the medical domain of the breast cancer disease. Our research's focus is twofold; our primary goal is to ensure consistency in clinical practice by importing clinical guidelines in an IT driven decision support system (DSS). Furthermore, we seek to improve visualization of disease specific, clinical data, providing for it's faster and more efficient use. (orig.)

  5. Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study

    Directory of Open Access Journals (Sweden)

    Ash Joan S

    2012-02-01

    Full Text Available Abstract Background The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS development and implementation and for knowledge management (KM processes in ambulatory clinics and community hospitals using commercial or locally developed systems in the U.S. Methods Guided by the Multiple Perspectives Framework, the authors conducted ethnographic field studies at two community hospitals and five ambulatory clinic organizations across the U.S. Using a Rapid Assessment Process, a multidisciplinary research team: gathered preliminary assessment data; conducted on-site interviews, observations, and field surveys; analyzed data using both template and grounded methods; and developed universal themes. A panel of experts produced recommended practices. Results The team identified ten themes related to CDS and KM. These include: 1 workflow; 2 knowledge management; 3 data as a foundation for CDS; 4 user computer interaction; 5 measurement and metrics; 6 governance; 7 translation for collaboration; 8 the meaning of CDS; 9 roles of special, essential people; and 10 communication, training, and support. Experts developed recommendations about each theme. The original Multiple Perspectives framework was modified to make explicit a new theoretical construct, that of Translational Interaction. Conclusions These ten themes represent areas that need attention if a clinic or community hospital plans to implement and successfully utilize CDS. In addition, they have implications for workforce education, research, and national-level policy development. The Translational Interaction construct could guide future applied informatics research endeavors.

  6. A proposed clinical decision support architecture capable of supporting whole genome sequence information.

    Science.gov (United States)

    Welch, Brandon M; Loya, Salvador Rodriguez; Eilbeck, Karen; Kawamoto, Kensaku

    2014-04-01

    Whole genome sequence (WGS) information may soon be widely available to help clinicians personalize the care and treatment of patients. However, considerable barriers exist, which may hinder the effective utilization of WGS information in a routine clinical care setting. Clinical decision support (CDS) offers a potential solution to overcome such barriers and to facilitate the effective use of WGS information in the clinic. However, genomic information is complex and will require significant considerations when developing CDS capabilities. As such, this manuscript lays out a conceptual framework for a CDS architecture designed to deliver WGS-guided CDS within the clinical workflow. To handle the complexity and breadth of WGS information, the proposed CDS framework leverages service-oriented capabilities and orchestrates the interaction of several independently-managed components. These independently-managed components include the genome variant knowledge base, the genome database, the CDS knowledge base, a CDS controller and the electronic health record (EHR). A key design feature is that genome data can be stored separately from the EHR. This paper describes in detail: (1) each component of the architecture; (2) the interaction of the components; and (3) how the architecture attempts to overcome the challenges associated with WGS information. We believe that service-oriented CDS capabilities will be essential to using WGS information for personalized medicine. PMID:25411644

  7. SeqReporter: automating next-generation sequencing result interpretation and reporting workflow in a clinical laboratory.

    Science.gov (United States)

    Roy, Somak; Durso, Mary Beth; Wald, Abigail; Nikiforov, Yuri E; Nikiforova, Marina N

    2014-01-01

    A wide repertoire of bioinformatics applications exist for next-generation sequencing data analysis; however, certain requirements of the clinical molecular laboratory limit their use: i) comprehensive report generation, ii) compatibility with existing laboratory information systems and computer operating system, iii) knowledgebase development, iv) quality management, and v) data security. SeqReporter is a web-based application developed using ASP.NET framework version 4.0. The client-side was designed using HTML5, CSS3, and Javascript. The server-side processing (VB.NET) relied on interaction with a customized SQL server 2008 R2 database. Overall, 104 cases (1062 variant calls) were analyzed by SeqReporter. Each variant call was classified into one of five report levels: i) known clinical significance, ii) uncertain clinical significance, iii) pending pathologists' review, iv) synonymous and deep intronic, and v) platform and panel-specific sequence errors. SeqReporter correctly annotated and classified 99.9% (859 of 860) of sequence variants, including 68.7% synonymous single-nucleotide variants, 28.3% nonsynonymous single-nucleotide variants, 1.7% insertions, and 1.3% deletions. One variant of potential clinical significance was re-classified after pathologist review. Laboratory information system-compatible clinical reports were generated automatically. SeqReporter also facilitated quality management activities. SeqReporter is an example of a customized and well-designed informatics solution to optimize and automate the downstream analysis of clinical next-generation sequencing data. We propose it as a model that may envisage the development of a comprehensive clinical informatics solution. PMID:24220144

  8. A clinical decision aid for the selection of antithrombotic therapy for the prevention of stroke due to atrial fibrillation

    DEFF Research Database (Denmark)

    LaHaye, Stephen Andrew; Gibbens, Sabra Lynn; Ball, David Gerald Andrew;

    2012-01-01

    The availability of new antithrombotic agents, each with a unique efficacy and bleeding profile, has introduced a considerable amount of clinical uncertainty with physicians. We have developed a clinical decision aid in order to assist clinicians in determining an optimal antithrombotic regime fo...... the prevention of stroke in patients who are newly diagnosed with non-valvular atrial fibrillation....

  9. An automated tuberculosis screening strategy combining X-ray-based computer-aided detection and clinical information

    Science.gov (United States)

    Melendez, Jaime; Sánchez, Clara I.; Philipsen, Rick H. H. M.; Maduskar, Pragnya; Dawson, Rodney; Theron, Grant; Dheda, Keertan; van Ginneken, Bram

    2016-01-01

    Lack of human resources and radiological interpretation expertise impair tuberculosis (TB) screening programmes in TB-endemic countries. Computer-aided detection (CAD) constitutes a viable alternative for chest radiograph (CXR) reading. However, no automated techniques that exploit the additional clinical information typically available during screening exist. To address this issue and optimally exploit this information, a machine learning-based combination framework is introduced. We have evaluated this framework on a database containing 392 patient records from suspected TB subjects prospectively recruited in Cape Town, South Africa. Each record comprised a CAD score, automatically computed from a CXR, and 12 clinical features. Comparisons with strategies relying on either CAD scores or clinical information alone were performed. Our results indicate that the combination framework outperforms the individual strategies in terms of the area under the receiving operating characteristic curve (0.84 versus 0.78 and 0.72), specificity at 95% sensitivity (49% versus 24% and 31%) and negative predictive value (98% versus 95% and 96%). Thus, it is believed that combining CAD and clinical information to estimate the risk of active disease is a promising tool for TB screening. PMID:27126741

  10. Exploring a Laboratory Model of Pharmacogenetics as Applied to Clinical Decision Making

    Directory of Open Access Journals (Sweden)

    Angela Smith, PharmD Candidate

    2013-01-01

    Full Text Available Objective: To evaluate a pilot of a laboratory model for relating pharmacogenetics to clinical decision making. Case Study: This pilot was undertaken and evaluated to help determine if a pharmacogenetics laboratory should be included in the core Doctor of Pharmacy curriculum. The placement of the laboratory exercise in the curriculum was determined by identifying the point in the curriculum where the students had been introduced to the chemistry of deoxyribonucleic acid (DNA as well as instructed on the chemistry of genetic variation. The laboratory included cytochrome P450 2C19 genotyping relative to the *2 variant. Twenty-four students served as the pilot group. Students provided buccal swabs as the source of DNA. Students stabilized the samples and were then provided instructions related to sample preparation, polymerase chain reaction, and gel electrophoresis. The results were reported as images of gels. Students used a reference gel image to compare their results to. Students then applied a dosing algorithm to make a “clinical decision” relative to clopidogrel use. Students were offered a post laboratory survey regarding attitudes toward the laboratory. Twenty-four students completed the laboratory with genotyping results being provided for 22 students (91.7%. Sixteen students were wild-type (*1/*1, while six students were heterozygous (*1/*2. Twenty-three students (96% completed the post laboratory survey. All 23 agreed (6, 26.1% or strongly agreed (17, 73.9% that the laboratory “had relevance and value in the pharmacy curriculum”. Conclusion: The post pilot study survey exploring a laboratory model for pharmacogenetics related to clinical decision making indicated that such a laboratory would be viewed positively by students. This model may be adopted by colleges to expand pharmacogenetics education.

  11. Proceedings of Joint International Symposium on the role of noninvasive imaging modalities in clinical decision making of coronary artery disease

    International Nuclear Information System (INIS)

    This report contains ten papers on the use of noninvasive imaging in clinical diagnosis and decision making. Topics include a cost analysis of magnetic resonance imaging in medical technology, diagnostic uses of MRI in chronic coronary artery disease, clinical applications of cine computed tomography, the use of PET as a clinical tool, and the use of echocardiography in coronary artery disease. Individual papers are processed separately for the data base

  12. Using clinical decision support as a means of implementing a universal postpartum depression screening program.

    Science.gov (United States)

    Loudon, Holly; Nentin, Farida; Silverman, Michael E

    2016-06-01

    A major barrier to the diagnosis of postpartum depression (PPD) includes symptom detection. The lack of awareness and understanding of PPD among new mothers, the variability in clinical presentation, and the various diagnostic strategies can increase this further. The purpose of this study was to test the feasibility of adding clinical decision support (CDS) to the electronic health record (EHR) as a means of implementing a universal standardized PPD screening program within a large, at high risk, population. All women returning to the Mount Sinai Hospital OB/GYN Ambulatory Practice for postpartum care between 2010 and 2013 were presented with the Edinburgh Postnatal Depression Scale (EPDS) in response to a CDS "hard stop" built into the EHR. Of the 2102 women who presented for postpartum care, 2092 women (99.5 %) were screened for PPD in response to a CDS hard stop module. Screens were missing on ten records (0.5 %) secondary to refusal, language barrier, or lack of clarity in the EHR. Technology is becoming increasingly important in addressing the challenges faced by health care providers. While the identification of PPD has become the recent focus of public health concerns secondary to the significant social burden, numerous barriers to screening still exist within the clinical setting. The utility of adding CDS in the form of a hard stop, requiring clinicians to enter a standardized PPD mood assessment score to the patient EHR, offers a sufficient way to address a primary barrier to PPD symptom identification at the practitioner level. PMID:26669601

  13. icuARM-An ICU Clinical Decision Support System Using Association Rule Mining

    Science.gov (United States)

    Chanani, Nikhil; Venugopalan, Janani; Maher, Kevin; Wang, May Dongmei

    2013-01-01

    The rapid development of biomedical monitoring technologies has enabled modern intensive care units (ICUs) to gather vast amounts of multimodal measurement data about their patients. However, processing large volumes of complex data in real-time has become a big challenge. Together with ICU physicians, we have designed and developed an ICU clinical decision support system icuARM based on associate rule mining (ARM), and a publicly available research database MIMIC-II (Multi-parameter Intelligent Monitoring in Intensive Care II) that contains more than 40,000 ICU records for 30,000+patients. icuARM is constructed with multiple association rules and an easy-to-use graphical user interface (GUI) for care providers to perform real-time data and information mining in the ICU setting. To validate icuARM, we have investigated the associations between patients' conditions such as comorbidities, demographics, and medications and their ICU outcomes such as ICU length of stay. Coagulopathy surfaced as the most dangerous co-morbidity that leads to the highest possibility (54.1%) of prolonged ICU stay. In addition, women who are older than 50 years have the highest possibility (38.8%) of prolonged ICU stay. For clinical conditions treatable with multiple drugs, icuARM suggests that medication choice can be optimized based on patient-specific characteristics. Overall, icuARM can provide valuable insights for ICU physicians to tailor a patient's treatment based on his or her clinical status in real time.

  14. Electronic clinical decision support systems attitudes and barriers to use in the oncology setting.

    LENUS (Irish Health Repository)

    Collins, I M

    2012-03-02

    BACKGROUND: There is little evidence regarding attitudes to clinical decision support systems (CDSS) in oncology. AIMS: We examined the current usage, awareness, and concerns of Irish medical oncologists and oncology pharmacists in this area. METHODS: A questionnaire was sent to 27 medical oncologists and 34 oncology pharmacists, identified through professional interest groups. Respondents ranked concerns regarding their use of a CDSS on a scale from 1 to 4, with 4 being most important. RESULTS: Overall, 67% (41\\/61) responded, 48% (13\\/27) of oncologists and 82% (28\\/34) of pharmacists surveyed. Concerns included "difficulty defining complex clinical situations with a set of rules" (mean ± SD) (3.2 ± 0.9), "ensuring evidence base is up to date and relevant" (3.2 ± 0.9) and "lack of clinically relevant suggestions" (2.9 ± 0.9). Ninety-three percent reported using a CDSS but 54% were unaware of this. CONCLUSION: While there are benefits to using a CDSS, concerns must be addressed through user education. This may be a starting point for a user-centred design approach to the development of future local systems through a consultative process.

  15. Automated production of [¹⁸F]VAT suitable for clinical PET study of vesicular acetylcholine transporter.

    Science.gov (United States)

    Yue, Xuyi; Bognar, Christopher; Zhang, Xiang; Gaehle, Gregory G; Moerlein, Stephen M; Perlmutter, Joel S; Tu, Zhude

    2016-01-01

    Automated production of a promising radiopharmaceutical (-)-(1-(8-(2-[(18)F]fluoroethoxy)-3-hydroxy-1,2,3,4-tetrahydronaphthalen-2-yl)-piperidin-4-yl)(4-fluorophenyl)methanone ([(18)F]VAT) for the vesicular acetylcholine transporter(VAChT) was achieved using a two-step procedure in a current Good Manufacturing Practices fashion. The production of [(18)F]VAT was accomplished in approximately 140 min, with radiochemical yield of ~15.0% (decay corrected), specific activity>111 GBq/µmol, radiochemical purity>99% and mass of VAT ~3.4 μg/batch (n>10). The radiopharmaceutical product meets all quality control criteria for human use, and is suitable for clinical PET studies of VAChT. PMID:26408913

  16. Service oriented architecture for clinical decision support: a systematic review and future directions.

    Science.gov (United States)

    Loya, Salvador Rodriguez; Kawamoto, Kensaku; Chatwin, Chris; Huser, Vojtech

    2014-12-01

    The use of a service-oriented architecture (SOA) has been identified as a promising approach for improving health care by facilitating reliable clinical decision support (CDS). A review of the literature through October 2013 identified 44 articles on this topic. The review suggests that SOA related technologies such as Business Process Model and Notation (BPMN) and Service Component Architecture (SCA) have not been generally adopted to impact health IT systems' performance for better care solutions. Additionally, technologies such as Enterprise Service Bus (ESB) and architectural approaches like Service Choreography have not been generally exploited among researchers and developers. Based on the experience of other industries and our observation of the evolution of SOA, we found that the greater use of these approaches have the potential to significantly impact SOA implementations for CDS. PMID:25325996

  17. An Investigation of Factors Influencing Nurses' Clinical Decision-Making Skills.

    Science.gov (United States)

    Wu, Min; Yang, Jinqiu; Liu, Lingying; Ye, Benlan

    2016-08-01

    This study aims to investigate the influencing factors on nurses' clinical decision-making (CDM) skills. A cross-sectional nonexperimental research design was conducted in the medical, surgical, and emergency departments of two university hospitals, between May and June 2014. We used a quantile regression method to identify the influencing factors across different quantiles of the CDM skills distribution and compared the results with the corresponding ordinary least squares (OLS) estimates. Our findings revealed that nurses were best at the skills of managing oneself. Educational level, experience, and the total structural empowerment had significant positive impacts on nurses' CDM skills, while the nurse-patient relationship, patient care and interaction, formal empowerment, and information empowerment were negatively correlated with nurses' CDM skills. These variables explained no more than 30% of the variance in nurses' CDM skills and mainly explained the lower quantiles of nurses' CDM skills distribution. PMID:26906246

  18. Fertility Intent and Contraceptive Decision-making among HIV Positive and Negative Antenatal Clinic Attendees in Durban, South Africa

    OpenAIRE

    Marlow, Heather M.; Maman, Suzanne; Groves, Allison K.; Moodley, Daya

    2012-01-01

    We explored contraceptive decision-making among South African antenatal clinic attendees, fertility intent post-HIV diagnosis, and women’s experiences at government health facilities. Data are from in-depth interviews with HIV negative and HIV positive women. We interviewed women in Zulu; interviews were recorded, transcribed and translated. We conducted qualitative analyses of interviews. Women were the dominant decision-makers about contraceptive use, whether they involved their partners or...

  19. Quantitative Imaging Biomarkers: The Application of Advanced Image Processing and Analysis to Clinical and Preclinical Decision Making

    OpenAIRE

    Prescott, Jeffrey William

    2012-01-01

    The importance of medical imaging for clinical decision making has been steadily increasing over the last four decades. Recently, there has also been an emphasis on medical imaging for preclinical decision making, i.e., for use in pharamaceutical and medical device development. There is also a drive towards quantification of imaging findings by using quantitative imaging biomarkers, which can improve sensitivity, specificity, accuracy and reproducibility of imaged characteristics used for dia...

  20. The 2013 symposium on pathology data integration and clinical decision support and the current state of field

    Directory of Open Access Journals (Sweden)

    Jason M Baron

    2014-01-01

    Full Text Available Background: Pathologists and informaticians are becoming increasingly interested in electronic clinical decision support for pathology, laboratory medicine and clinical diagnosis. Improved decision support may optimize laboratory test selection, improve test result interpretation and permit the extraction of enhanced diagnostic information from existing laboratory data. Nonetheless, the field of pathology decision support is still developing. To facilitate the exchange of ideas and preliminary studies, we convened a symposium entitled: Pathology data integration and clinical decision support. Methods: The symposium was held at the Massachusetts General Hospital, on May 10, 2013. Participants were selected to represent diverse backgrounds and interests and were from nine different institutions in eight different states. Results: The day included 16 plenary talks and three panel discussions, together covering four broad areas. Summaries of each presentation are included in this manuscript. Conclusions: A number of recurrent themes emerged from the symposium. Among the most pervasive was the dichotomy between diagnostic data and diagnostic information, including the opportunities that laboratories may have to use electronic systems and algorithms to convert the data they generate into more useful information. Differences between human talents and computer abilities were described; well-designed symbioses between humans and computers may ultimately optimize diagnosis. Another key theme related to the unique needs and challenges in providing decision support for genomics and other emerging diagnostic modalities. Finally, many talks relayed how the barriers to bringing decision support toward reality are primarily personnel, political, infrastructural and administrative challenges rather than technological limitations.

  1. Privacy-Preserving Patient-Centric Clinical Decision Support System on Naïve Bayesian Classification.

    Science.gov (United States)

    Liu, Ximeng; Lu, Rongxing; Ma, Jianfeng; Chen, Le; Qin, Baodong

    2016-03-01

    Clinical decision support system, which uses advanced data mining techniques to help clinician make proper decisions, has received considerable attention recently. The advantages of clinical decision support system include not only improving diagnosis accuracy but also reducing diagnosis time. Specifically, with large amounts of clinical data generated everyday, naïve Bayesian classification can be utilized to excavate valuable information to improve a clinical decision support system. Although the clinical decision support system is quite promising, the flourish of the system still faces many challenges including information security and privacy concerns. In this paper, we propose a new privacy-preserving patient-centric clinical decision support system, which helps clinician complementary to diagnose the risk of patients' disease in a privacy-preserving way. In the proposed system, the past patients' historical data are stored in cloud and can be used to train the naïve Bayesian classifier without leaking any individual patient medical data, and then the trained classifier can be applied to compute the disease risk for new coming patients and also allow these patients to retrieve the top- k disease names according to their own preferences. Specifically, to protect the privacy of past patients' historical data, a new cryptographic tool called additive homomorphic proxy aggregation scheme is designed. Moreover, to leverage the leakage of naïve Bayesian classifier, we introduce a privacy-preserving top- k disease names retrieval protocol in our system. Detailed privacy analysis ensures that patient's information is private and will not be leaked out during the disease diagnosis phase. In addition, performance evaluation via extensive simulations also demonstrates that our system can efficiently calculate patient's disease risk with high accuracy in a privacy-preserving way. PMID:26960216

  2. Clinical Performance and Management Outcomes with the DecisionDx-UM Gene Expression Profile Test in a Prospective Multicenter Study

    Directory of Open Access Journals (Sweden)

    Kristen Meldi Plasseraud

    2016-01-01

    Full Text Available Uveal melanoma management is challenging due to its metastatic propensity. DecisionDx-UM is a prospectively validated molecular test that interrogates primary tumor biology to provide objective information about metastatic potential that can be used in determining appropriate patient care. To evaluate the continued clinical validity and utility of DecisionDx-UM, beginning March 2010, 70 patients were enrolled in a prospective, multicenter, IRB-approved study to document patient management differences and clinical outcomes associated with low-risk Class 1 and high-risk Class 2 results indicated by DecisionDx-UM testing. Thirty-seven patients in the prospective study were Class 1 and 33 were Class 2. Class 1 patients had 100% 3-year metastasis-free survival compared to 63% for Class 2 (log rank test p=0.003 with 27.3 median follow-up months in this interim analysis. Class 2 patients received significantly higher-intensity monitoring and more oncology/clinical trial referrals compared to Class 1 patients (Fisher’s exact test p=2.1×10-13 and p=0.04, resp.. The results of this study provide additional, prospective evidence in an independent cohort of patients that Class 1 and Class 2 patients are managed according to the differential metastatic risk indicated by DecisionDx-UM. The trial is registered with Clinical Application of DecisionDx-UM Gene Expression Assay Results (NCT02376920.

  3. A semi-automated, field-portable microscopy platform for clinical diagnostic applications

    Science.gov (United States)

    Jagannadh, Veerendra Kalyan; Srinivasan, Rajesh; Gorthi, Sai Siva

    2015-08-01

    Clinical microscopy is a versatile diagnostic platform used for diagnosis of a multitude of diseases. In the recent past, many microfluidics based point-of-care diagnostic devices have been developed, which serve as alternatives to microscopy. However, these point-of-care devices are not as multi-functional and versatile as clinical microscopy. With the use of custom designed optics and microfluidics, we have developed a versatile microscopy-based cellular diagnostic platform, which can be used at the point of care. The microscopy platform presented here is capable of detecting infections of very low parasitemia level (in a very small quantity of sample), without the use of any additional computational hardware. Such a cost-effective and portable diagnostic device, would greatly impact the quality of health care available to people living in rural locations of the world. Apart from clinical diagnostics, it's applicability to field research in environmental microbiology has also been outlined.

  4. From pioneering to implementing automated blood pressure measurement in clinical practice: Thomas Pickering's legacy

    DEFF Research Database (Denmark)

    Stolarz-Skrzypek, Katarzyna; Thijs, Lutgarde; Wizner, Barbara;

    2010-01-01

    Thomas G. Pickering spent most of his scientific career in carrying out research on clinical hypertension and blood pressure (BP) measurement. In our review of Pickering's seminal work, we first focused on white-coat hypertension and masked hypertension, two terms that he had introduced. Next, we...... involving white-coat hypertension and masked hypertension, diurnal BP variability, and self-measured BP. Recent studies validated Pickering's observations in terms of cardiovascular outcome and bridged the path from concept to application in clinical practice....

  5. Using Personal Health Records for Automated Clinical Trials Recruitment: the ePaIRing Model

    OpenAIRE

    Wilcox, Adam; Natarajan, Karthik; Weng, Chunhua

    2009-01-01

    We describe the development of a model describing the use of patient information to improve patient recruitment in clinical trials. This model, named ePaIRing (electronic Participant Identification and Recruitment Model) describes variations in how information flows between stakeholders, and how personal health records can specifically facilitate patient recruitment.

  6. Automated objective routine examination of optical quality of rigid endoscopes in a clinical setting.

    Science.gov (United States)

    Wientjes, Rens; Noordmans, Herke J; van der Eijk, Jerine A J; van den Brink, Henk

    2013-01-01

    Rigid endoscopes degrade during clinical use due to sterilization, ionizing radiation and mechanical forces. Despite visual checks on functionality at the department of sterilization, surgeons are still confronted with suboptimal instruments as it is difficult to assess this degradation in an objective manner. To guarantee that endoscopes have sufficient optical quality for minimal invasive surgery, an experimental opto-electronic test bench has been developed in order to be used at the department of sterilization. Transmission of illumination fibres and lens contrast values are stored in a database to enable empirical criteria to reject endoscope for further clinical usage or to accept endoscopes after repair. Results of the test bench are given for an eight month period, where a trained operator performed 1599 measurements on 46 different types. Stability of the system, trends in quality of clinical endoscopes, and effect of repair or replacement were assessed. Although the period was too short to draw firm conclusions, a slow downwards trend in quality of clinically used endoscopes could be observed. Also, endoscopes generally improve in quality after repair or replacement, while endoscope replacement seems to slightly outperform endoscope repair. To optimize the measurement process, a new system is being developed requiring less user interaction and measuring more optical parameters of an endoscope. By commercializing this system, we hope that measurements at different hospitals will give improved insight which acceptance and rejection criteria to use and which factors (usage, cleaning protocol, and brands) determine the economic lifetime of endoscopes. PMID:23555715

  7. OpEx - a validated, automated pipeline optimised for clinical exome sequence analysis.

    Science.gov (United States)

    Ruark, Elise; Münz, Márton; Clarke, Matthew; Renwick, Anthony; Ramsay, Emma; Elliott, Anna; Seal, Sheila; Lunter, Gerton; Rahman, Nazneen

    2016-01-01

    We present an easy-to-use, open-source Optimised Exome analysis tool, OpEx (http://icr.ac.uk/opex) that accurately detects small-scale variation, including indels, to clinical standards. We evaluated OpEx performance with an experimentally validated dataset (the ICR142 NGS validation series), a large 1000 exome dataset (the ICR1000 UK exome series), and a clinical proband-parent trio dataset. The performance of OpEx for high-quality base substitutions and short indels in both small and large datasets is excellent, with overall sensitivity of 95%, specificity of 97% and low false detection rate (FDR) of 3%. Depending on the individual performance requirements the OpEx output allows one to optimise the inevitable trade-offs between sensitivity and specificity. For example, in the clinical setting one could permit a higher FDR and lower specificity to maximise sensitivity. In contexts where experimental validation is not possible, minimising the FDR and improving specificity may be a preferable trade-off for slightly lower sensitivity. OpEx is simple to install and use; the whole pipeline is run from a single command. OpEx is therefore well suited to the increasing research and clinical laboratories undertaking exome sequencing, particularly those without in-house dedicated bioinformatics expertise. PMID:27485037

  8. OpEx - a validated, automated pipeline optimised for clinical exome sequence analysis

    Science.gov (United States)

    Ruark, Elise; Münz, Márton; Clarke, Matthew; Renwick, Anthony; Ramsay, Emma; Elliott, Anna; Seal, Sheila; Lunter, Gerton; Rahman, Nazneen

    2016-01-01

    We present an easy-to-use, open-source Optimised Exome analysis tool, OpEx (http://icr.ac.uk/opex) that accurately detects small-scale variation, including indels, to clinical standards. We evaluated OpEx performance with an experimentally validated dataset (the ICR142 NGS validation series), a large 1000 exome dataset (the ICR1000 UK exome series), and a clinical proband-parent trio dataset. The performance of OpEx for high-quality base substitutions and short indels in both small and large datasets is excellent, with overall sensitivity of 95%, specificity of 97% and low false detection rate (FDR) of 3%. Depending on the individual performance requirements the OpEx output allows one to optimise the inevitable trade-offs between sensitivity and specificity. For example, in the clinical setting one could permit a higher FDR and lower specificity to maximise sensitivity. In contexts where experimental validation is not possible, minimising the FDR and improving specificity may be a preferable trade-off for slightly lower sensitivity. OpEx is simple to install and use; the whole pipeline is run from a single command. OpEx is therefore well suited to the increasing research and clinical laboratories undertaking exome sequencing, particularly those without in-house dedicated bioinformatics expertise. PMID:27485037

  9. Comparison of residents’ approaches to clinical decisions before and after the implementation of Evidence Based Medicine course

    Directory of Open Access Journals (Sweden)

    ZAHRA KARIMIAN

    2014-10-01

    Full Text Available Introduction: It has been found that the decision-making process in medicine is affected, to a large extent, by one’s experience, individual mentality, previous models, and common habitual approaches, in addition to scientific principles. Evidence-based medicine is an approach attempting to reinforce scientific, systematic and critical thinking in physicians and provide the ground for optimal decision making. In this connection, the purpose of the present study is to find out to what extent the education of evidence based medicine affects clinical decision making. Methods: The present quasi-experimental study was carried out on 110 clinical residents, who started their education in September, 2012 and finally 62 residents filled out the questionnaires. The instrument used was a researchermade questionnaire containing items on four decision-making approaches. The questionnaire was used both as a pre-test and a post-test to assess the residents’ viewpoints on decision making approaches. The validity of the questionnaire was determined using medical education and clinical professionals’ viewpoints, and the reliability was calculated through Chronbach alpha; it was found to be 0.93. The results were analyzed by paired t-test using SPSS, version 14. Results: The results demonstrated that evidence-based medicine workshop significantly affected the residents’ decision-making approaches (p<0.001. The pre-test showed that principles-based, reference-based and routine model-based approaches were more preferred before the program (p<0.001. However, after the implementation of the program, the dominant approaches used by the residents in their decision making were evidence-based ones. Conclusion: To develop the evidence-based approach, it is necessary for educational programs to continue steadily and goal-orientedly. In addition, the equipment infrastructure such as the Internet, access to data bases, scientific data, and clinical guides should

  10. Chronic hepatitis C: Treat or wait? Medical decision making in clinical practice

    Institute of Scientific and Technical Information of China (English)

    Claus Niederau; Dietrich Hüppe; Elmar Zehnter; Bernd M(o)ller; Renate Heyne; Stefan Christensen; Rainer Pfaff

    2012-01-01

    AIM:To analyzes the decision whether patients with chronic hepatitis C virus (HCV) infection are treated or not.METHODS:This prospective cohort study included 7658 untreated patients and 6341 patients receiving pegylated interferon α2a/ribavirin,involving 434 physicians/institutions throughout Germany (377 in private practice and 57 in hospital settings).A structured questionnaire had to be answered prior to the treatment decision,which included demographic data,information about the personal life situation of the patients,anamnesis and symptomatology of hepatitis C,virological data,laboratory data and data on concomitant diseases.A second part of the study analyzes patients treated with pegylated interferon α2a.All questionnaires included reasons against treatment mentioned by the physician.RESULTS:Overall treatment uptake was 45%.By multivariate analysis,genotype 1/4/5/6,HCV-RNA ≤ 520 000 IU/mL,normal alanine aminotransferase (ALT),platelets ≤ 142 500/μL,age > 56 years,female gender,infection length > 12.5 years,concomitant diseases,human immunodeficiency virus co-infection,liver biopsy not performed,care in private practice,asymptomatic disease,and unemployment were factors associated with reduced treatment rate.Treatment and sustained viral response rates in migrants (1/3 of cohort) were higher than in German natives although 1/3 of migrants had language problems.Treatment rate and liver biopsy were higher in clinical settings when compared to private practice and were low when ALT and HCV-RNA were low.CONCLUSION:Some reasons against treatment were medically based whereas others were related to fears,socio-economical problems,and information deficits both on the side of physicians and patients.

  11. Automated Broad-Range Molecular Detection of Bacteria in Clinical Samples.

    Science.gov (United States)

    Budding, Andries E; Hoogewerf, Martine; Vandenbroucke-Grauls, Christina M J E; Savelkoul, Paul H M

    2016-04-01

    Molecular detection methods, such as quantitative PCR (qPCR), have found their way into clinical microbiology laboratories for the detection of an array of pathogens. Most routinely used methods, however, are directed at specific species. Thus, anything that is not explicitly searched for will be missed. This greatly limits the flexibility and universal application of these techniques. We investigated the application of a rapid universal bacterial molecular identification method, IS-pro, to routine patient samples received in a clinical microbiology laboratory. IS-pro is a eubacterial technique based on the detection and categorization of 16S-23S rRNA gene interspace regions with lengths that are specific for each microbial species. As this is an open technique, clinicians do not need to decide in advance what to look for. We compared routine culture to IS-pro using 66 samples sent in for routine bacterial diagnostic testing. The samples were obtained from patients with infections in normally sterile sites (without a resident microbiota). The results were identical in 20 (30%) samples, IS-pro detected more bacterial species than culture in 31 (47%) samples, and five of the 10 culture-negative samples were positive with IS-pro. The case histories of the five patients from whom these culture-negative/IS-pro-positive samples were obtained suggest that the IS-pro findings are highly clinically relevant. Our findings indicate that an open molecular approach, such as IS-pro, may have a high added value for clinical practice. PMID:26763956

  12. Validation of the Sysmex sp-1000i automated slide preparer-stainer in a clinical laboratory

    Directory of Open Access Journals (Sweden)

    Eberson Damiao dos Santos de Bitencourt

    2013-01-01

    Full Text Available Background: The speed and quality of information have become essential items in the release of laboratory reports. The Sysmex®SP1000-I device has been developed to prepare and stain smear slides. However, for a device to be cleared for use in the laboratory routine it must pass through a validation process. Objective: To evaluate the performance and reliability of the Sysmex® SP-1000i slide preparer-stainer incorporated into the routine of a hospital laboratory in Porto Alegre. Methods: Peripheral blood samples of patients attending the laboratory for ambulatory exams with leukocyte counts between 7000/°L and 12,000/°L were evaluated, independent of gender and age. Two slides were prepared for each sample using the Sysmex® SP-1000i equipment; one of the slides was used to perform quality control tests using the CellaVision® DM96 device, and the other slide was used to compare pre-classification by the same device and the classification performed by a pharmacist-biochemist. Results: The results of all the slides used as controls were acceptable according to the quality control test as established by the manufacturer of the device. In the comparison between the automated pre-classification and the classification made by the professional, there was an acceptable variation in the differential counts of leukocytes for 90% of the analyzed slides. Pearson correlation coefficient showed a strong correlation for band neutrophils (r = 0.802; p-value < 0.001, segmented neutrophils (r = 0.963; p-value < 0.001, eosinophils (r = 0.958; p-value < 0.001, lymphocytes (r = 0.985; p-value < 0.001 and atypical lymphocytes (r = 0.866; p-value < 0.001 using both methods. The red blood cell analysis was adequate for all slides analyzed by the equipment and by the professional. Conclusion: The new Sysmex®SP1000-i methodology was found to be reliable, fast and safe for the routines of medium and large laboratories, improving the quality of microscopic analysis in

  13. An HL7-CDA wrapper for facilitating semantic interoperability to rule-based Clinical Decision Support Systems

    OpenAIRE

    Sáez Silvestre, Carlos; BRESÓ GUARDADO, ADRIÁN; Vicente Robledo, Javier; Robles Viejo, Montserrat; García Gómez, Juan Miguel

    2013-01-01

    The success of Clinical Decision Support Systems (CDSS) greatly depends on its capability of being integrated in Health Information Systems (HIS). Several proposals have been published up to date to permit CDSS gathering patient data from HIS. Some base the CDSS data input on the HL7 reference model, however, they are tailored to specific CDSS or clinical guidelines technologies, or do not focus on standardizing the CDSS resultant knowledge. We propose a solution for facilitating semantic int...

  14. Construction of a Clinical Decision Support System for Undergoing Surgery Based on Domain Ontology and Rules Reasoning

    OpenAIRE

    Bau, Cho-Tsan; Chen, Rung-Ching; Huang, Chung-Yi

    2014-01-01

    Objective: To construct a clinical decision support system (CDSS) for undergoing surgery based on domain ontology and rules reasoning in the setting of hospitalized diabetic patients. Materials and Methods: The ontology was created with a modified ontology development method, including specification and conceptualization, formalization, implementation, and evaluation and maintenance. The Protégé–Web Ontology Language editor was used to implement the ontology. Embedded clinical knowle...

  15. Integration and evaluation of automated Monte Carlo simulations in the clinical practice of scanned proton and carbon ion beam therapy

    International Nuclear Information System (INIS)

    Monte Carlo (MC) simulations of beam interaction and transport in matter are increasingly considered as essential tools to support several aspects of radiation therapy. Despite the vast application of MC to photon therapy and scattered proton therapy, clinical experience in scanned ion beam therapy is still scarce. This is especially the case for ions heavier than protons, which pose additional issues like nuclear fragmentation and varying biological effectiveness. In this work, we present the evaluation of a dedicated framework which has been developed at the Heidelberg Ion Beam Therapy Center to provide automated FLUKA MC simulations of clinical patient treatments with scanned proton and carbon ion beams. Investigations on the number of transported primaries and the dimension of the geometry and scoring grids have been performed for a representative class of patient cases in order to provide recommendations on the simulation settings, showing that recommendations derived from the experience in proton therapy cannot be directly translated to the case of carbon ion beams. The MC results with the optimized settings have been compared to the calculations of the analytical treatment planning system (TPS), showing that regardless of the consistency of the two systems (in terms of beam model in water and range calculation in different materials) relevant differences can be found in dosimetric quantities and range, especially in the case of heterogeneous and deep seated treatment sites depending on the ion beam species and energies, homogeneity of the traversed tissue and size of the treated volume. The analysis of typical TPS speed-up approximations highlighted effects which deserve accurate treatment, in contrast to adequate beam model simplifications for scanned ion beam therapy. In terms of biological dose calculations, the investigation of the mixed field components in realistic anatomical situations confirmed the findings of previous groups so far reported only in

  16. Automated characterization of perceptual quality of clinical chest radiographs: Validation and calibration to observer preference

    International Nuclear Information System (INIS)

    Purpose: The authors previously proposed an image-based technique [Y. Lin et al. Med. Phys. 39, 7019–7031 (2012)] to assess the perceptual quality of clinical chest radiographs. In this study, an observer study was designed and conducted to validate the output of the program against rankings by expert radiologists and to establish the ranges of the output values that reflect the acceptable image appearance so the program output can be used for image quality optimization and tracking. Methods: Using an IRB-approved protocol, 2500 clinical chest radiographs (PA/AP) were collected from our clinical operation. The images were processed through our perceptual quality assessment program to measure their appearance in terms of ten metrics of perceptual image quality: lung gray level, lung detail, lung noise, rib–lung contrast, rib sharpness, mediastinum detail, mediastinum noise, mediastinum alignment, subdiaphragm–lung contrast, and subdiaphragm area. From the results, for each targeted appearance attribute/metric, 18 images were selected such that the images presented a relatively constant appearance with respect to all metrics except the targeted one. The images were then incorporated into a graphical user interface, which displayed them into three panels of six in a random order. Using a DICOM calibrated diagnostic display workstation and under low ambient lighting conditions, each of five participating attending chest radiologists was tasked to spatially order the images based only on the targeted appearance attribute regardless of the other qualities. Once ordered, the observer also indicated the range of image appearances that he/she considered clinically acceptable. The observer data were analyzed in terms of the correlations between the observer and algorithmic rankings and interobserver variability. An observer-averaged acceptable image appearance was also statistically derived for each quality attribute based on the collected individual acceptable ranges

  17. Automated characterization of perceptual quality of clinical chest radiographs: Validation and calibration to observer preference

    Energy Technology Data Exchange (ETDEWEB)

    Samei, Ehsan, E-mail: samei@duke.edu [Carl E. Ravin Advanced Imaging Laboratories, Departments of Radiology, Physics, Biomedical Engineering, Electrical and Computer Engineering, Medical Physics Graduate Program, Duke Clinical Imaging Physics Group, Duke University, Durham, North Carolina 27710 (United States); Lin, Yuan [Carl E. Ravin Advanced Imaging Laboratories, Departments of Radiology and Physics, Duke University, Durham, North Carolina 27710 (United States); Choudhury, Kingshuk R. [Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology and Biostatistics and Bioinformatics, Duke University, Durham, North Carolina 27710 (United States); Page McAdams, H. [Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Duke University, Durham, North Carolina 27710 (United States)

    2014-11-01

    Purpose: The authors previously proposed an image-based technique [Y. Lin et al. Med. Phys. 39, 7019–7031 (2012)] to assess the perceptual quality of clinical chest radiographs. In this study, an observer study was designed and conducted to validate the output of the program against rankings by expert radiologists and to establish the ranges of the output values that reflect the acceptable image appearance so the program output can be used for image quality optimization and tracking. Methods: Using an IRB-approved protocol, 2500 clinical chest radiographs (PA/AP) were collected from our clinical operation. The images were processed through our perceptual quality assessment program to measure their appearance in terms of ten metrics of perceptual image quality: lung gray level, lung detail, lung noise, rib–lung contrast, rib sharpness, mediastinum detail, mediastinum noise, mediastinum alignment, subdiaphragm–lung contrast, and subdiaphragm area. From the results, for each targeted appearance attribute/metric, 18 images were selected such that the images presented a relatively constant appearance with respect to all metrics except the targeted one. The images were then incorporated into a graphical user interface, which displayed them into three panels of six in a random order. Using a DICOM calibrated diagnostic display workstation and under low ambient lighting conditions, each of five participating attending chest radiologists was tasked to spatially order the images based only on the targeted appearance attribute regardless of the other qualities. Once ordered, the observer also indicated the range of image appearances that he/she considered clinically acceptable. The observer data were analyzed in terms of the correlations between the observer and algorithmic rankings and interobserver variability. An observer-averaged acceptable image appearance was also statistically derived for each quality attribute based on the collected individual acceptable ranges

  18. Depression and Anxiety During Pregnancy: Evaluating the Literature in Support of Clinical Risk-Benefit Decision-Making.

    Science.gov (United States)

    Dalke, Katharine Baratz; Wenzel, Amy; Kim, Deborah R

    2016-06-01

    Depression and anxiety during pregnancy are common, and patients and providers are faced with complex decisions regarding various treatment modalities. A structured discussion of the risks and benefits of options with the patient and her support team is recommended to facilitate the decision-making process. This clinically focused review, with emphasis on the last 3 years of published study data, evaluates the major risk categories of medication treatments, namely pregnancy loss, physical malformations, growth impairment, behavioral teratogenicity, and neonatal toxicity. Nonpharmacological treatment options, including neuromodulation and psychotherapy, are also briefly reviewed. Specific recommendations, drawn from the literature and the authors' clinical experience, are also offered to help guide the clinician in decision-making. PMID:27091646

  19. An Exploration of the Relationship between Clinical Decision-Making Ability and Educational Preparation among New Graduate Nurses

    Science.gov (United States)

    Blount, Kamilah V.

    2013-01-01

    This study examined the impact of accelerated nursing direct entry master's programs on the development of clinical decision-making skills of new graduate nurses that completed the Performance Based Development System (PBDS) assessment during the study period of 2008-2012 at a healthcare organization. Healthcare today is practiced in a…

  20. C-reactive protein and white blood cell count do not improve clinical decision-making in acute appendicitis

    DEFF Research Database (Denmark)

    Tind, Sofie; Lassen, Annmarie Touborg; Zimmermann-Nielsen, Erik;

    2015-01-01

    INTRODUCTION: Acute appendicitis (AA) remains a diagnostic challenge as indicated by the high rate of unnecessary surgery. Blood samples, primarily C-reactive protein (CRP) and leucocyte counts, are used as a diagnostic supplement despite their relatively low sensitivities and specificities...... leucocyte counts did not influence clinical decision-making....

  1. Clinical information system services and capabilities desired for scalable, standards-based, service-oriented decision support: consensus assessment of the Health Level 7 clinical decision support Work Group.

    Science.gov (United States)

    Kawamoto, Kensaku; Jacobs, Jason; Welch, Brandon M; Huser, Vojtech; Paterno, Marilyn D; Del Fiol, Guilherme; Shields, David; Strasberg, Howard R; Haug, Peter J; Liu, Zhijing; Jenders, Robert A; Rowed, David W; Chertcoff, Daryl; Fehre, Karsten; Adlassnig, Klaus-Peter; Curtis, A Clayton

    2012-01-01

    A standards-based, service-oriented architecture for clinical decision support (CDS) has the potential to significantly enhance CDS scalability and robustness. To enable such a CDS architecture, the Health Level 7 CDS Work Group reviewed the literature, hosted multi-stakeholder discussions, and consulted domain experts to identify and prioritize the services and capabilities required from clinical information systems (CISs) to enable service-oriented CDS. In addition, relevant available standards were identified. Through this process, ten CIS services and eight CIS capabilities were identified as being important for enabling scalable, service-oriented CDS. In particular, through a survey of 46 domain experts, five services and capabilities were identified as being especially critical: 1) the use of standard information models and terminologies; 2) the ability to leverage a Decision Support Service (DSS); 3) support for a clinical data query service; 4) support for an event subscription and notification service; and 5) support for a user communication service. PMID:23304315

  2. Development of online quality assurance automation tool "SmartQC" for radiotherapy clinics

    Science.gov (United States)

    Zaks, Daniel

    Radiotherapy has existed as a clinical medical procedure since as early as 1900, and has become an essential component of modern hospitals. It is predicted that, sometime between the years 2010 and 2020, the number of patients receiving radiation therapy during their initial treatment is expected to rise by 22% from 470,000 per year to 575,000 per year Due to the potential for harm in radiotherapy, quality assurance is an essential element at every stage of modern clinical workflow. The quality and use of time in QA procedures and checks is an important issue that has significant impact on both practice and research in the field of radiotherapy. This thesis documents the results of development and results of tools addressing that question. While the motivation for radiotherapy QA is principally about improving quality of patient care, and developing radiotherapy research tools, we also discuss the relevance of QA to radiotherapy malpractice lawsuits and related financial costs. We show that in the treatment plan check performed by the medical physicist---also known as the second check or physics check---a substantial fraction (~33%) of the average time is spent on non-physics related analysis. We also demonstrate the development and implementation of a web-based system, referred to as PlanTracker within this thesis, to track the status of the plan. This thesis concludes with further developments being considered as an outgrowth of this system.

  3. Clinical Decision Support Tools for Selecting Interventions for Patients with Disabling Musculoskeletal Disorders: A Scoping Review.

    Science.gov (United States)

    Gross, Douglas P; Armijo-Olivo, Susan; Shaw, William S; Williams-Whitt, Kelly; Shaw, Nicola T; Hartvigsen, Jan; Qin, Ziling; Ha, Christine; Woodhouse, Linda J; Steenstra, Ivan A

    2016-09-01

    Purpose We aimed to identify and inventory clinical decision support (CDS) tools for helping front-line staff select interventions for patients with musculoskeletal (MSK) disorders. Methods We used Arksey and O'Malley's scoping review framework which progresses through five stages: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies for analysis; (4) charting the data; and (5) collating, summarizing and reporting results. We considered computer-based, and other available tools, such as algorithms, care pathways, rules and models. Since this research crosses multiple disciplines, we searched health care, computing science and business databases. Results Our search resulted in 4605 manuscripts. Titles and abstracts were screened for relevance. The reliability of the screening process was high with an average percentage of agreement of 92.3 %. Of the located articles, 123 were considered relevant. Within this literature, there were 43 CDS tools located. These were classified into 3 main areas: computer-based tools/questionnaires (n = 8, 19 %), treatment algorithms/models (n = 14, 33 %), and clinical prediction rules/classification systems (n = 21, 49 %). Each of these areas and the associated evidence are described. The state of evidentiary support for CDS tools is still preliminary and lacks external validation, head-to-head comparisons, or evidence of generalizability across different populations and settings. Conclusions CDS tools, especially those employing rapidly advancing computer technologies, are under development and of potential interest to health care providers, case management organizations and funders of care. Based on the results of this scoping review, we conclude that these tools, models and systems should be subjected to further validation before they can be recommended for large-scale implementation for managing patients with MSK disorders. PMID:26667939

  4. A fuzzy logic decision support system for assessing clinical nutritional risk

    Directory of Open Access Journals (Sweden)

    Ali Mohammad Hadianfard

    2015-04-01

    Full Text Available Introduction: Studies have indicated a global high prevalence of hospital malnutrition on admission and during hospitalization. Clinical Nutritional Risk Screen (CNRS is a way to identify malnutrition and manage nutritional interventions. Several traditional and non-computer based tools have been suggested for screening nutritional risk levels. The present study was an attempt to employ a computer based fuzzy model decision support system as a nutrition-screening tool for inpatients. Method: This is an applied modeling study. The system architecture was designed based on the fuzzy logic model including input data, inference engine, and output. A clinical nutritionist entered nineteen input variables using a windows-based graphical user interface. The inference engine was involved with knowledge obtained from literature and the construction of ‘IF-THEN’ rules. The output of the system was stratification of patients into four risk levels from ‘No’ to ‘High’ where a number was also allocated to them as a nutritional risk grade. All patients (121 people admitted during implementing the system participated in testing the model. The classification tests were used to measure the CNRS fuzzy model performance. IBM SPSS version 21 was utilized as a tool for data analysis with α = 0.05 as a significance level. Results: Results showed that sensitivity, specificity, accuracy, and precision of the fuzzy model performance were 91.67% (±4.92, 76% (±7.6, 88.43% (±5.7, and 93.62% (±4.32, respectively. Instant performance on admission and very low probability of mistake in predicting malnutrition risk level may justify using the model in hospitals. Conclusion: To conclude, the fuzzy model-screening tool is based on multiple nutritional risk factors, having the capability of classifying inpatients into several nutritional risk levels and identifying the level of required nutritional intervention.

  5. MACVIA clinical decision algorithm in adolescents and adults with allergic rhinitis.

    Science.gov (United States)

    Bousquet, Jean; Schünemann, Holger J; Hellings, Peter W; Arnavielhe, Sylvie; Bachert, Claus; Bedbrook, Anna; Bergmann, Karl-Christian; Bosnic-Anticevich, Sinthia; Brozek, Jan; Calderon, Moises; Canonica, G Walter; Casale, Thomas B; Chavannes, Niels H; Cox, Linda; Chrystyn, Henry; Cruz, Alvaro A; Dahl, Ronald; De Carlo, Giuseppe; Demoly, Pascal; Devillier, Phillipe; Dray, Gérard; Fletcher, Monica; Fokkens, Wytske J; Fonseca, Joao; Gonzalez-Diaz, Sandra N; Grouse, Lawrence; Keil, Thomas; Kuna, Piotr; Larenas-Linnemann, Désirée; Lodrup Carlsen, Karin C; Meltzer, Eli O; Mullol, Jaoquim; Muraro, Antonella; Naclerio, Robert N; Palkonen, Susanna; Papadopoulos, Nikolaos G; Passalacqua, Giovanni; Price, David; Ryan, Dermot; Samolinski, Boleslaw; Scadding, Glenis K; Sheikh, Aziz; Spertini, François; Valiulis, Arunas; Valovirta, Erkka; Walker, Samantha; Wickman, Magnus; Yorgancioglu, Arzu; Haahtela, Tari; Zuberbier, Torsten

    2016-08-01

    The selection of pharmacotherapy for patients with allergic rhinitis (AR) depends on several factors, including age, prominent symptoms, symptom severity, control of AR, patient preferences, and cost. Allergen exposure and the resulting symptoms vary, and treatment adjustment is required. Clinical decision support systems (CDSSs) might be beneficial for the assessment of disease control. CDSSs should be based on the best evidence and algorithms to aid patients and health care professionals to jointly determine treatment and its step-up or step-down strategy depending on AR control. Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon (MACVIA-LR [fighting chronic diseases for active and healthy ageing]), one of the reference sites of the European Innovation Partnership on Active and Healthy Ageing, has initiated an allergy sentinel network (the MACVIA-ARIA Sentinel Network). A CDSS is currently being developed to optimize AR control. An algorithm developed by consensus is presented in this article. This algorithm should be confirmed by appropriate trials. PMID:27260321

  6. Four Principles for User Interface Design of Computerised Clinical Decision Support Systems

    DEFF Research Database (Denmark)

    Kanstrup, Anne Marie; Christiansen, Marion Berg; Nøhr, Christian

    2011-01-01

    Abstract.  The paper presents results from design of a user interface for a Computerised Clinical Decision Support System (CSSS). The ambition has been to design Human-Computer Interaction that can minimise medication errors. Through an iterative design process a digital prototype for prescriptio...... four interaction principles are integrated in the design of user interfaces for CDSS, i.e. the model is an integrated model which we suggest as a guide for interaction design when working with preventing medication errors....... of medicine has been developed. This paper presents results from the formative evaluation of the prototype conducted in a simulation laboratory with ten participating physicians. Data from the simulation is analysed by use of theory on how users perceive information. The conclusion is a model, which...... emphasises a focus on how users interact with the system, a focus on how information is provided by the system, and four principles of interaction. The four principles for design of user interfaces for CDSS are summarised as four A’s: All in one, At a glance, At hand and Attention. It is recommended that all...

  7. Molecular profiling of liver tumors: classification and clinical translation for decision making.

    Science.gov (United States)

    Pinyol, Roser; Nault, Jean Charles; Quetglas, Iris M; Zucman-Rossi, Jessica; Llovet, Josep M

    2014-11-01

    Hepatocellular carcinoma (HCC) is a complex disease with a dismal prognosis. Consequently, a translational approach is required to personalized clinical decision making to improve survival of HCC patients. Molecular signatures from cirrhotic livers and single nucleotide polymorphism have been linked with HCC occurrence. Identification of high-risk populations will be useful to design chemopreventive trials. In addition, molecular signatures derived from tumor and nontumor samples are associated with early tumor recurrence due to metastasis and late tumor recurrence due to de novo carcinogenesis after curative treatment, respectively. Identification of patients with a high risk of relapse will guide adjuvant randomized trials. The genetic landscape drawn by next-generation sequencing has highlighted the genomic diversity of HCC. Genetic drivers recurrently mutated belong to different signaling pathways including telomere maintenance, cell-cycle regulators, chromatin remodeling, Wnt/b-catenin, RAS/RAF/MAPK kinase, and AKT/mTOR pathway. These cancer genes will be ideally targeted by biotherapies as a paradigm of stratified medicine adapted to tumor biology. PMID:25369299

  8. Towards computerizing intensive care sedation guidelines: design of a rule-based architecture for automated execution of clinical guidelines

    Directory of Open Access Journals (Sweden)

    Kerckhove Wannes

    2010-01-01

    Full Text Available Abstract Background Computerized ICUs rely on software services to convey the medical condition of their patients as well as assisting the staff in taking treatment decisions. Such services are useful for following clinical guidelines quickly and accurately. However, the development of services is often time-consuming and error-prone. Consequently, many care-related activities are still conducted based on manually constructed guidelines. These are often ambiguous, which leads to unnecessary variations in treatments and costs. The goal of this paper is to present a semi-automatic verification and translation framework capable of turning manually constructed diagrams into ready-to-use programs. This framework combines the strengths of the manual and service-oriented approaches while decreasing their disadvantages. The aim is to close the gap in communication between the IT and the medical domain. This leads to a less time-consuming and error-prone development phase and a shorter clinical evaluation phase. Methods A framework is proposed that semi-automatically translates a clinical guideline, expressed as an XML-based flow chart, into a Drools Rule Flow by employing semantic technologies such as ontologies and SWRL. An overview of the architecture is given and all the technology choices are thoroughly motivated. Finally, it is shown how this framework can be integrated into a service-oriented architecture (SOA. Results The applicability of the Drools Rule language to express clinical guidelines is evaluated by translating an example guideline, namely the sedation protocol used for the anaesthetization of patients, to a Drools Rule Flow and executing and deploying this Rule-based application as a part of a SOA. The results show that the performance of Drools is comparable to other technologies such as Web Services and increases with the number of decision nodes present in the Rule Flow. Most delays are introduced by loading the Rule Flows

  9. Implementing shared decision-making in nutrition clinical practice: A theory-based approach and feasibility study

    Directory of Open Access Journals (Sweden)

    Légaré France

    2008-11-01

    Full Text Available Abstract Background There are a growing number of dietary treatment options to choose from for the management of many chronic diseases. Shared decision making represents a promising approach to improve the quality of the decision making process needed for dietary choices that are informed by the best evidence and value-based. However, there are no studies reporting on theory-based approaches that foster the implementation of shared decision making in health professions allied to medicine. The objectives of this study are to explore the integration of shared decision making within real nutritional consultations, and to design questionnaires to assess dieticians' intention to adopt two specific behaviors related to shared decision making using the Theory of Planned Behavior. Methods Forty dieticians will audiotape one clinical encounter to explore the presence of shared decision making within the consultation. They will also participate to one of five to six focus groups that aim to identify the salient beliefs underlying the determinants of their intention to present evidence-based dietary treatment options to their patients, and clarify the values related to dietary choices that are important to their patients. These salient beliefs will be used to elaborate the items of two questionnaires. The internal consistency of theoretical constructs and the temporal stability of their measurement will be checked using the test-retest method by asking 35 dieticians to complete the questionnaire twice within a two-week interval. Discussion The proposed research project will be the first study to: provide preliminary data about the adoption of shared decision making by dieticians and theirs patients; elicit dieticians' salient beliefs regarding the intention to adopt shared decision making behaviors, report on the development of a specific questionnaire; explore dieticians' views on the implementation of shared decision making; and compare their views

  10. Clinical feasibility of 3D automated coronary atherosclerotic plaque quantification algorithm on coronary computed tomography angiography: Comparison with intravascular ultrasound

    International Nuclear Information System (INIS)

    To evaluate the diagnostic performance of automated coronary atherosclerotic plaque quantification (QCT) by different users (expert/non-expert/automatic). One hundred fifty coronary artery segments from 142 patients who underwent coronary computed tomography angiography (CCTA) and intravascular ultrasound (IVUS) were analyzed. Minimal lumen area (MLA), maximal lumen area stenosis percentage (%AS), mean plaque burden percentage (%PB), and plaque volume were measured semi-automatically by expert, non-expert, and fully automatic QCT analyses, and then compared to IVUS. Between IVUS and expert QCT analysis, the correlation coefficients (r) for the MLA, %AS, %PB, and plaque volume were excellent: 0.89 (p < 0.001), 0.84 (p < 0.001), 0.91 (p < 0.001), and 0.94 (p < 0.001), respectively. There were no significant differences in the mean parameters (all p values >0.05) except %AS (p = 0.01). The automatic QCT analysis showed comparable performance to non-expert QCT analysis, showing correlation coefficients (r) of the MLA (0.80 vs. 0.82), %AS (0.82 vs. 0.80), %PB (0.84 vs. 0.73), and plaque volume (0.84 vs. 0.79) when they were compared to IVUS, respectively. Fully automatic QCT analysis showed clinical utility compared with IVUS, as well as a compelling performance when compared with semiautomatic analyses. (orig.)

  11. Clinical feasibility of 3D automated coronary atherosclerotic plaque quantification algorithm on coronary computed tomography angiography: Comparison with intravascular ultrasound

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hyung-Bok [Yonsei University Health System, Yonsei-Cedar Sinai Integrative Cardiovascular Imaging Research Center, Seoul (Korea, Republic of); Myongji Hospital, Division of Cardiology, Cardiovascular Center, Goyang (Korea, Republic of); Lee, Byoung Kwon [Yonsei University College of Medicine, Division of Cardiology, Gangnam Severance Hospital, Seoul (Korea, Republic of); Shin, Sanghoon [Yonsei University Health System, Yonsei-Cedar Sinai Integrative Cardiovascular Imaging Research Center, Seoul (Korea, Republic of); National Health Insurance Corporation Ilsan Hospital, Division of Cardiology, Goyang (Korea, Republic of); Heo, Ran; Chang, Hyuk-Jae; Chung, Namsik [Yonsei University Health System, Yonsei-Cedar Sinai Integrative Cardiovascular Imaging Research Center, Seoul (Korea, Republic of); Yonsei University Health System, Division of Cardiology, Severance Cardiovascular Hospital, Seoul (Korea, Republic of); Arsanjani, Reza [Cedars-Sinai Medical Center, Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Los Angeles, CA (United States); Kitslaar, Pieter H. [Leiden University Medical Center, Department of Radiology, Division of Image Processing, Leiden (Netherlands); Medis medical Imaging Systems B.V., Leiden (Netherlands); Broersen, Alexander; Dijkstra, Jouke [Leiden University Medical Center, Department of Radiology, Division of Image Processing, Leiden (Netherlands); Ahn, Sung Gyun [Yonsei University Wonju Severance Christian Hospital, Division of Cardiology, Wonju (Korea, Republic of); Min, James K. [New York-Presbyterian Hospital, Institute for Cardiovascular Imaging, Weill-Cornell Medical College, New York, NY (United States); Hong, Myeong-Ki; Jang, Yangsoo [Yonsei University Health System, Division of Cardiology, Severance Cardiovascular Hospital, Seoul (Korea, Republic of)

    2015-10-15

    To evaluate the diagnostic performance of automated coronary atherosclerotic plaque quantification (QCT) by different users (expert/non-expert/automatic). One hundred fifty coronary artery segments from 142 patients who underwent coronary computed tomography angiography (CCTA) and intravascular ultrasound (IVUS) were analyzed. Minimal lumen area (MLA), maximal lumen area stenosis percentage (%AS), mean plaque burden percentage (%PB), and plaque volume were measured semi-automatically by expert, non-expert, and fully automatic QCT analyses, and then compared to IVUS. Between IVUS and expert QCT analysis, the correlation coefficients (r) for the MLA, %AS, %PB, and plaque volume were excellent: 0.89 (p < 0.001), 0.84 (p < 0.001), 0.91 (p < 0.001), and 0.94 (p < 0.001), respectively. There were no significant differences in the mean parameters (all p values >0.05) except %AS (p = 0.01). The automatic QCT analysis showed comparable performance to non-expert QCT analysis, showing correlation coefficients (r) of the MLA (0.80 vs. 0.82), %AS (0.82 vs. 0.80), %PB (0.84 vs. 0.73), and plaque volume (0.84 vs. 0.79) when they were compared to IVUS, respectively. Fully automatic QCT analysis showed clinical utility compared with IVUS, as well as a compelling performance when compared with semiautomatic analyses. (orig.)

  12. Emerging medical informatics with case-based reasoning for aiding clinical decision in multi-agent system.

    Science.gov (United States)

    Shen, Ying; Colloc, Joël; Jacquet-Andrieu, Armelle; Lei, Kai

    2015-08-01

    This research aims to depict the methodological steps and tools about the combined operation of case-based reasoning (CBR) and multi-agent system (MAS) to expose the ontological application in the field of clinical decision support. The multi-agent architecture works for the consideration of the whole cycle of clinical decision-making adaptable to many medical aspects such as the diagnosis, prognosis, treatment, therapeutic monitoring of gastric cancer. In the multi-agent architecture, the ontological agent type employs the domain knowledge to ease the extraction of similar clinical cases and provide treatment suggestions to patients and physicians. Ontological agent is used for the extension of domain hierarchy and the interpretation of input requests. Case-based reasoning memorizes and restores experience data for solving similar problems, with the help of matching approach and defined interfaces of ontologies. A typical case is developed to illustrate the implementation of the knowledge acquisition and restitution of medical experts. PMID:26133480

  13. Documentation-based clinical decision support to improve antibiotic prescribing for acute respiratory infections in primary care: a cluster randomised controlled trial

    OpenAIRE

    Jeffrey Linder; Jeffrey Schnipper; Ruslana Tsurikova; Tony Yu; Lynn Volk; Andrea Melnikas; Matvey Palchuk; Maya Olsha-Yehiav; Blackford Middleton

    2009-01-01

    Background and objective Clinical guidelines discourage antibiotic prescribing for many acute respiratory infections (ARIs), especially for non-antibiotic appropriate diagnoses. Electronic health record (EHR)-based clinical decision support has the potential to improve antibiotic prescribing for ARIs. Methods We randomly assigned 27 primary care clinics to receive an EHR-integrated, documentation based clinical decision support system for the care of patients with ARIs - the ARI Smart Form...

  14. The clinical characteristics of fungal keratitis in eyes after Descemet’s stripping and automated endothelial keratoplasty

    Directory of Open Access Journals (Sweden)

    Araki-Sasaki K

    2014-09-01

    Full Text Available Kaoru Araki-Sasaki,1,2 Atsuko Fukumoto,1 Yasuhiro Osakabe,3 Hideya Kimura,1 Shinichiro Kuroda1 1Nagata Eye Clinic, Nara, Japan; 2Department of Ophthalmology, Japan Community Health Care Organization, Hoshigaoka Medical Center, Osaka, Japan; 3Department of Molecular Pathology, Tokyo Medical University, Tokyo, Japan Abstract: The purpose of this study was to describe the clinical characteristics of fungal keratitis caused by Candida albicans in an eye after Descemet stripping automated endothelial keratoplasty (DSAEK. A 72-year-old male with a history of three trabeculectomies, cataract surgery, and two DSAEK procedures developed a corneal ulcer in his right eye two years after his last DSAEK. Fungal keratitis was most likely related to the immunosuppressive conditions that occurred due to the previous operations, the continuous use of steroid eye drops, and the use of disposable soft contact lenses. A smear and culture from the ulcer detected Candida albicans. Slit-lamp examination showed the characteristic feature was the presence of interface infiltrates located between the host and the graft cornea and in the enlarged area around the ulcer. Two weeks after intense antimycotic treatments with voriconazole, miconazole, and natamycin, perforation of the cornea occurred and further therapeutic penetrating keratoplasty was required. Histological analysis revealed an accumulation of infiltrated cells and fibrotic tissue. The poor prognosis for fungal keratitis that occurs in eyes after undergoing DSAEK may be related to the rapid expansion of inflammatory cells through the interface between the host and the graft. In eyes that develop fungal keratitis after DSAEK, special attention should be paid to the possibility that perforation could occur in these patients. Keywords: DSAEK, Candida albicans, fungal keratitis, keratomycosis, post-operative infection

  15. Healthcare decision-making in end stage renal disease-patient preferences and clinical correlates

    OpenAIRE

    Jayanti, Anuradha; Neuvonen, Markus; Wearden, Alison; Morris, Julie; Foden, Philip; Brenchley, Paul,; Mitra, Sandip; ,

    2015-01-01

    Background Medical decision-making is critical to patient survival and well-being. Patients with end stage renal disease (ESRD) are faced with incrementally complex decision-making throughout their treatment journey. The extent to which patients seek involvement in the decision-making process and factors which influence these in ESRD need to be understood. Methods 535 ESRD patients were enrolled into the cross-sectional study arm and 30 patients who started dialysis were prospectively evaluat...

  16. Enabling cross-platform clinical decision support through Web-based decision support in commercial electronic health record systems: proposal and evaluation of initial prototype implementations.

    Science.gov (United States)

    Zhang, Mingyuan; Velasco, Ferdinand T; Musser, R Clayton; Kawamoto, Kensaku

    2013-01-01

    Enabling clinical decision support (CDS) across multiple electronic health record (EHR) systems has been a desired but largely unattained aim of clinical informatics, especially in commercial EHR systems. A potential opportunity for enabling such scalable CDS is to leverage vendor-supported, Web-based CDS development platforms along with vendor-supported application programming interfaces (APIs). Here, we propose a potential staged approach for enabling such scalable CDS, starting with the use of custom EHR APIs and moving towards standardized EHR APIs to facilitate interoperability. We analyzed three commercial EHR systems for their capabilities to support the proposed approach, and we implemented prototypes in all three systems. Based on these analyses and prototype implementations, we conclude that the approach proposed is feasible, already supported by several major commercial EHR vendors, and potentially capable of enabling cross-platform CDS at scale. PMID:24551426

  17. Confidence and Information Access in Clinical Decision-Making: An Examination of the Cognitive Processes that affect the Information-seeking Behavior of Physicians

    OpenAIRE

    Uy, Raymonde Charles; Sarmiento, Raymond Francis; Gavino, Alex; Fontelo, Paul

    2014-01-01

    Clinical decision-making involves the interplay between cognitive processes and physicians’ perceptions of confidence in the context of their information-seeking behavior. The objectives of the study are: to examine how these concepts interact, to determine whether physician confidence, defined in relation to information need, affects clinical decision-making, and if information access improves decision accuracy. We analyzed previously collected data about resident physicians’ perceptions of ...

  18. Clinical Trial Decision Making in Pediatric Sickle Cell Disease: A Qualitative Study of Perceived Benefits and Barriers to Participation.

    Science.gov (United States)

    Patterson, Chavis A; Chavez, Veronica; Mondestin, Valerie; Deatrick, Janet; Li, Yimei; Barakat, Lamia P

    2015-08-01

    Clinical trial research forms the foundation for advancing treatments; yet, children with sickle cell disease (SCD) are currently underrepresented. This qualitative study examines decision-making processes of youth with SCD and their caregivers regarding enrollment in clinical trial research. A subsample of participants from a study of clinical trial decision making among youth with health disparity conditions, 23 caregivers and 29 children/teens/young adults with SCD (age, 10 to 29 y), indicated whether or not they would participate in hypothetical medical and psychosocial clinical trials and prioritized barriers and benefits to participation via card sort and semistructured interviews. Audio recordings were transcribed and coded for themes. Participants reported that concerns of potential harm most affected their decision. Secondary factors were potential benefit, manageable study demands, and trust in the medical staff. Caregivers weighed potential harm more heavily than their children. Young children were more likely to endorse potential benefit. Overall, participants stated they would be willing to participate in research if the potential benefit outweighs potential harm and unmanageable study demands. To optimize recruitment, results suggest addressing potential harm first while highlighting potential benefits, creating manageable study demands, and endorsing the future benefits of research to the sickle cell community. PMID:25072368

  19. Computerized clinical decision support systems for acute care management: A decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes

    Directory of Open Access Journals (Sweden)

    Sahota Navdeep

    2011-08-01

    Full Text Available Abstract Background Acute medical care often demands timely, accurate decisions in complex situations. Computerized clinical decision support systems (CCDSSs have many features that could help. However, as for any medical intervention, claims that CCDSSs improve care processes and patient outcomes need to be rigorously assessed. The objective of this review was to systematically review the effects of CCDSSs on process of care and patient outcomes for acute medical care. Methods We conducted a decision-maker-researcher partnership systematic review. MEDLINE, EMBASE, Evidence-Based Medicine Reviews databases (Cochrane Database of Systematic Reviews, DARE, ACP Journal Club, and others, and the Inspec bibliographic database were searched to January 2010, in all languages, for randomized controlled trials (RCTs of CCDSSs in all clinical areas. We included RCTs that evaluated the effect on process of care or patient outcomes of a CCDSS used for acute medical care compared with care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement if at least 50% of the relevant study outcomes were statistically significantly positive. Results Thirty-six studies met our inclusion criteria for acute medical care. The CCDSS improved process of care in 63% (22/35 of studies, including 64% (9/14 of medication dosing assistants, 82% (9/11 of management assistants using alerts/reminders, 38% (3/8 of management assistants using guidelines/algorithms, and 67% (2/3 of diagnostic assistants. Twenty studies evaluated patient outcomes, of which three (15% reported improvements, all of which were medication dosing assistants. Conclusion The majority of CCDSSs demonstrated improvements in process of care, but patient outcomes were less likely to be evaluated and far less likely to show positive results.

  20. The problematic of decision-sharing: deconstructing 'cholesterol' in a clinical encounter.

    NARCIS (Netherlands)

    Gwyn, R.; Elwyn, G.; Edwards, A.; Mooney, A.

    2003-01-01

    Shared decision-making is increasingly advocated as a means of interacting with patients but there is also a widely accepted view that many factors will militate against this ideal. While some patients may not wish to take on the responsibility of decision-making, it is also evident that many find i

  1. Fully Automated Simultaneous Integrated Boosted-Intensity Modulated Radiation Therapy Treatment Planning Is Feasible for Head-and-Neck Cancer: A Prospective Clinical Study

    Energy Technology Data Exchange (ETDEWEB)

    Wu Binbin, E-mail: binbin.wu@gunet.georgetown.edu [Department of Radiation Oncology and Molecular Radiation Science, Johns Hopkins University, Baltimore, Maryland (United States); Department of Radiation Medicine, Georgetown University Hospital, Washington, DC (United States); McNutt, Todd [Department of Radiation Oncology and Molecular Radiation Science, Johns Hopkins University, Baltimore, Maryland (United States); Zahurak, Marianna [Department of Oncology Biostatistics, Johns Hopkins University, Baltimore, Maryland (United States); Simari, Patricio [Autodesk Research, Toronto, ON (Canada); Pang, Dalong [Department of Radiation Medicine, Georgetown University Hospital, Washington, DC (United States); Taylor, Russell [Department of Computer Science, Johns Hopkins University, Baltimore, Maryland (United States); Sanguineti, Giuseppe [Department of Radiation Oncology and Molecular Radiation Science, Johns Hopkins University, Baltimore, Maryland (United States)

    2012-12-01

    Purpose: To prospectively determine whether overlap volume histogram (OVH)-driven, automated simultaneous integrated boosted (SIB)-intensity-modulated radiation therapy (IMRT) treatment planning for head-and-neck cancer can be implemented in clinics. Methods and Materials: A prospective study was designed to compare fully automated plans (APs) created by an OVH-driven, automated planning application with clinical plans (CPs) created by dosimetrists in a 3-dose-level (70 Gy, 63 Gy, and 58.1 Gy), head-and-neck SIB-IMRT planning. Because primary organ sparing (cord, brain, brainstem, mandible, and optic nerve/chiasm) always received the highest priority in clinical planning, the study aimed to show the noninferiority of APs with respect to PTV coverage and secondary organ sparing (parotid, brachial plexus, esophagus, larynx, inner ear, and oral mucosa). The sample size was determined a priori by a superiority hypothesis test that had 85% power to detect a 4% dose decrease in secondary organ sparing with a 2-sided alpha level of 0.05. A generalized estimating equation (GEE) regression model was used for statistical comparison. Results: Forty consecutive patients were accrued from July to December 2010. GEE analysis indicated that in APs, overall average dose to the secondary organs was reduced by 1.16 (95% CI = 0.09-2.33) with P=.04, overall average PTV coverage was increased by 0.26% (95% CI = 0.06-0.47) with P=.02 and overall average dose to the primary organs was reduced by 1.14 Gy (95% CI = 0.45-1.8) with P=.004. A physician determined that all APs could be delivered to patients, and APs were clinically superior in 27 of 40 cases. Conclusions: The application can be implemented in clinics as a fast, reliable, and consistent way of generating plans that need only minor adjustments to meet specific clinical needs.

  2. Using a service oriented architecture approach to clinical decision support: performance results from two CDS Consortium demonstrations.

    Science.gov (United States)

    Paterno, Marilyn D; Goldberg, Howard S; Simonaitis, Linas; Dixon, Brian E; Wright, Adam; Rocha, Beatriz H; Ramelson, Harley Z; Middleton, Blackford

    2012-01-01

    The Clinical Decision Support Consortium has completed two demonstration trials involving a web service for the execution of clinical decision support (CDS) rules in one or more electronic health record (EHR) systems. The initial trial ran in a local EHR at Partners HealthCare. A second EHR site, associated with Wishard Memorial Hospital, Indianapolis, IN, was added in the second trial. Data were gathered during each 6 month period and analyzed to assess performance, reliability, and response time in the form of means and standard deviations for all technical components of the service, including assembling and preparation of input data. The mean service call time for each period was just over 2 seconds. In this paper we report on the findings and analysis to date while describing the areas for further analysis and optimization as we continue to expand our use of a Services Oriented Architecture approach for CDS across multiple institutions. PMID:23304342

  3. The doctor-patient relationship as a toolkit for uncertain clinical decisions.

    Science.gov (United States)

    Diamond-Brown, Lauren

    2016-06-01

    Medical uncertainty is a well-recognized problem in healthcare, yet how doctors make decisions in the face of uncertainty remains to be understood. This article draws on interdisciplinary literature on uncertainty and physician decision-making to examine a specific physician response to uncertainty: using the doctor-patient relationship as a toolkit. Additionally, I ask what happens to this process when the doctor-patient relationship becomes fragmented. I answer these questions by examining obstetrician-gynecologists' narratives regarding how they make decisions when faced with uncertainty in childbirth. Between 2013 and 2014, I performed 21 semi-structured interviews with obstetricians in the United States. Obstetricians were selected to maximize variation in relevant physician, hospital, and practice characteristics. I began with grounded theory and moved to analytical coding of themes in relation to relevant literature. My analysis renders it evident that some physicians use the doctor-patient relationship as a toolkit for dealing with uncertainty. I analyze how this process varies for physicians in different models of care by comparing doctors' experiences in models with continuous versus fragmented doctor-patient relationships. My key findings are that obstetricians in both models appealed to the ideal of patient-centered decision-making to cope with uncertain decisions, but in practice physicians in fragmented care faced a number of challenges to using the doctor-patient relationship as a toolkit for decision-making. These challenges led to additional uncertainties and in some cases to poor outcomes for doctors and/or patients; they also raised concerns about the reproduction of inequality. Thus organization of care delivery mitigates the efficacy of doctors' use of the doctor-patient relationship toolkit for uncertain decisions. These findings have implications for theorizing about decision-making under conditions of medical uncertainty, for understanding

  4. Evaluating a Web-Based Clinical Decision Support System for Language Disorders Screening in a Nursery School

    OpenAIRE

    Martín Ruiz, María Luisa; Valero Duboy, Miguel Angel; Torcal Loriente, Carmen; Pau de la Cruz, Iván

    2014-01-01

    Background: Early and effective identification of developmental disorders during childhood remains a critical task for the international community. The second highest prevalence of common developmental disorders in children are language delays, which are frequently the first symptoms of a possible disorder. Objective: This paper evaluates a Web-based Clinical Decision Support System (CDSS) whose aim is to enhance the screening of language disorders at a nursery school. The common lack of earl...

  5. Randomised controlled trial of clinical decision support tools to improve learning of evidence based medicine in medical students

    OpenAIRE

    Leung, Gabriel M; Johnston, Janice M; Tin, Keith Y K; Wong, Irene O. L.; Ho, Lai-Ming; Lam, Wendy W.T.; Lam, Tai-hing

    2003-01-01

    Objective: To assess the educational effectiveness on learning evidence based medicine of a handheld computer clinical decision support tool compared with a pocket card containing guidelines and a control. Design: Randomised controlled trial. Setting University of Hong Kong, 2001. Participants: 169 fourth year medical students. Main outcome measures: Factor and individual item scores from a validated questionnaire on five key self reported measures: personal application and current use of evi...

  6. Attitudes towards Prosthodontic Clinical Decision-Making for Edentulous Patients among South West Deanery Dental Foundation Year One Dentists

    OpenAIRE

    Andrew Barber; James Puryer; Sam Leary; Lisa McNally; Dominic O’Sullivan

    2016-01-01

    The aim of this study was to describe Dental Foundation year one dentists’ attitudes towards prosthodontic decision making for edentulous patients, and identify whether there are gender differences in these attitudes. All South West Deanery trainees were invited to take part in the study between May and June 2011 and a previously piloted questionnaire was administered to the trainees by their training programme directors. The questionnaire posed questions based upon a clinical scenario of dis...

  7. Knowledge of Fecal Calprotectin and Infliximab Trough Levels Alters Clinical Decision-making for IBD Outpatients on Maintenance Infliximab Therapy

    OpenAIRE

    Huang, Vivian W; Prosser, Connie; Kroeker, Karen I.; Wang, Haili; Shalapay, Carol; Dhami, Neil; Fedorak, Darryl K; Halloran, Brendan; Dieleman, Levinus A.; Goodman, Karen J; Richard N Fedorak

    2015-01-01

    Background: Infliximab is an effective therapy for inflammatory bowel disease (IBD). However, more than 50% of patients lose response. Empiric dose intensification is not effective for all patients because not all patients have objective disease activity or subtherapeutic drug level. The aim was to determine how an objective marker of disease activity or therapeutic drug monitoring affects clinical decisions regarding maintenance infliximab therapy in outpatients with IBD. Methods: Consecutiv...

  8. Implementation of Clinical Pharmacogenomics within a Large Health System: From Electronic Health Record Decision Support to Consultation Services.

    Science.gov (United States)

    Hicks, J Kevin; Stowe, David; Willner, Marc A; Wai, Maya; Daly, Thomas; Gordon, Steven M; Lashner, Bret A; Parikh, Sumit; White, Robert; Teng, Kathryn; Moss, Timothy; Erwin, Angelika; Chalmers, Jeffrey; Eng, Charis; Knoer, Scott

    2016-08-01

    The number of clinically relevant gene-based guidelines and recommendations pertaining to drug prescribing continues to grow. Incorporating gene-drug interaction information into the drug-prescribing process can help optimize pharmacotherapy outcomes and improve patient safety. However, pharmacogenomic implementation barriers exist such as integration of pharmacogenomic results into electronic health records (EHRs), development and deployment of pharmacogenomic decision support tools to EHRs, and feasible models for establishing ambulatory pharmacogenomic clinics. We describe the development of pharmacist-managed pharmacogenomic services within a large health system. The Clinical Pharmacogenetics Implementation Consortium guidelines for HLA-B*57:01-abacavir, HLA-B*15:02-carbamazepine, and TPMT-thiopurines (i.e., azathioprine, mercaptopurine, and thioguanine) were systematically integrated into patient care. Sixty-three custom rules and alerts (20 for TPMT-thiopurines, 8 for HLA-B*57:01-abacavir, and 35 for HLA-B*15:02-anticonvulsants) were developed and deployed to the EHR for the purpose of providing point-of-care pharmacogenomic decision support. In addition, a pharmacist and physician-geneticist collaboration established a pharmacogenomics ambulatory clinic. This clinic provides genetic testing when warranted, result interpretation along with pharmacotherapy recommendations, and patient education. Our processes for developing these pharmacogenomic services and solutions for addressing implementation barriers are presented. PMID:27312955

  9. Design and Development of a Sharable Clinical Decision Support System Based on a Semantic Web Service Framework.

    Science.gov (United States)

    Zhang, Yi-Fan; Gou, Ling; Tian, Yu; Li, Tian-Chang; Zhang, Mao; Li, Jing-Song

    2016-05-01

    Clinical decision support (CDS) systems provide clinicians and other health care stakeholders with patient-specific assessments or recommendations to aid in the clinical decision-making process. Despite their demonstrated potential for improving health care quality, the widespread availability of CDS systems has been limited mainly by the difficulty and cost of sharing CDS knowledge among heterogeneous healthcare information systems. The purpose of this study was to design and develop a sharable clinical decision support (S-CDS) system that meets this challenge. The fundamental knowledge base consists of independent and reusable knowledge modules (KMs) to meet core CDS needs, wherein each KM is semantically well defined based on the standard information model, terminologies, and representation formalisms. A semantic web service framework was developed to identify, access, and leverage these KMs across diverse CDS applications and care settings. The S-CDS system has been validated in two distinct client CDS applications. Model-level evaluation results confirmed coherent knowledge representation. Application-level evaluation results reached an overall accuracy of 98.66 % and a completeness of 96.98 %. The evaluation results demonstrated the technical feasibility and application prospect of our approach. Compared with other CDS engineering efforts, our approach facilitates system development and implementation and improves system maintainability, scalability and efficiency, which contribute to the widespread adoption of effective CDS within the healthcare domain. PMID:27002818

  10. Personalised Medicine Possible With Real-Time Integration of Genomic and Clinical Data To Inform Clinical Decision-Making.

    Science.gov (United States)

    Martin-Sanchez, Fernando; Turner, Maureen; Johnstone, Alice; Heffer, Leon; Rafael, Naomi; Bakker, Tim; Thorne, Natalie; Macciocca, Ivan; Gaff, Clara

    2015-01-01

    Despite widespread use of genomic sequencing in research, there are gaps in our understanding of the performance and provision of genomic sequencing in clinical practice. The Melbourne Genomics Health Alliance (the Alliance), has been established to determine the feasibility, performance and impact of using genomic sequencing as a diagnostic tool. The Alliance has partnered with BioGrid Australia to enable the linkage of genomic sequencing, clinical treatment and outcome data for this project. This integrated dataset of genetic, clinical and patient sourced information will be used by the Alliance to evaluate the potential diagnostic value of genomic sequencing in routine clinical practice. This project will allow the Alliance to provide recommendations to facilitate the integration of genomic sequencing into clinical practice to enable personalised disease treatment. PMID:26262351

  11. Local control after radiosurgery for brain metastases: predictive factors and implications for clinical decision

    International Nuclear Information System (INIS)

    To evaluate the local control of brain metastases (BM) in patients treated with stereotactic radiosurgery (SRS), correlate the outcome with treatment parameters and lesion characteristics, and define its implications for clinical decisions. Between 2007 and 2012, 305 BM in 141 consecutive patients were treated with SRS. After exclusions, 216 BM in 100 patients were analyzed. Doses were grouped as follows: ≤15 Gy, 16–20 Gy, and ≥21 Gy. Sizes were classified as ≤10 mm and >10 mm. Local control (LC) and overall survival (OS) were estimated using the Kaplan-Meier method. Log-rank statistics were used to identify the prognostic factors affecting LC and OS. For multivariate analyses, a Cox proportional model was applied including all potentially significant variables reached on univariate analyses. Median age was 54 years (18–80). Median radiological follow-up of the lesions was 7 months (1–66). Median LC and the LC at 1 year were 22.3 months and 69.7%, respectively. On univariate analysis, tumor size, SRS dose, and previous whole brain irradiation (WBRT) were significant factors for LC. Patients with lesions >10 and ≤10 mm had an LC at 1 year of 58.6% and 79.1%, respectively (p = 0.008). In lesions receiving ≤15 Gy, 16–20 Gy, and ≥21 Gy, the 1-year LC rates were 39.6%, 71.7%, and 92.3%, respectively (p < 0.001). When WBRT was done previously, LC at 1 year was 57.9% compared with 78.4% for those who did not undergo WBRT (p = 0.004). On multivariate analysis, dose remained the single most powerful prognostic factor for LC. Median OS for all patients was 17 months, with no difference among the groups. Dose is the most important predictive factor for LC of BM. Doses below 16 Gy correlated with poor LC. The SRS dose as salvage treatment after previous WBRT should not be reduced unless there is a pressing reason to do so

  12. A computer-aided differential diagnosis between UIP and NSIP using automated assessment of the extent and distribution of regional disease patterns at HRCT: comparison with the radiologist's decision

    Science.gov (United States)

    Kim, Namkug; Seo, Joon Beom; Park, Sang Ok; Lee, Youngjoo; Lee, Jeongjin

    2009-02-01

    To evaluate the accuracy of computer aided differential diagnosis (CADD) between usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP) at HRCT in comparison with that of a radiologist's decision. A computerized classification for six local disease patterns (normal, NL; ground-glass opacity, GGO; reticular opacity, RO; honeycombing, HC; emphysema, EM; and consolidation, CON) using texture/shape analyses and a SVM classifier at HRCT was used for pixel-by-pixel labeling on the whole lung area. The mode filter was applied on the results to reduce noise. Area fraction (AF) of each pattern, directional probabilistic density function (pdf) (dPDF: mean, SD, skewness of pdf /3 directions: superior-inferior, anterior-posterior, central-peripheral), regional cluster distribution pattern (RCDP: number, mean, SD of clusters, mean, SD of centroid of clusters) were automatically evaluated. Spatially normalized left and right lungs were evaluated separately. Disease division index (DDI) on every combination of AFs and asymmetric index (AI) between left and right lung ((left-right)/left) were also evaluated. To assess the accuracy of the system, fifty-four HRCT data sets in patients with pathologically diagnosed UIP (n=26) and NSIP (n=28) were used. For a classification procedure, a CADD-SVM classifier with internal parameter optimization, and sequential forward floating feature selection (SFFS) were employed. The accuracy was assessed by a 5-folding cross validation with 20- times repetition. For comparison, two thoracic radiologists reviewed the whole HRCT images without clinical information and diagnose each case either as UIP or NSIP. The accuracies of radiologists' decision were 0.75 and 0.87, respectively. The accuracies of the CADD system using the features of AF, dPDF, AI of dPDF, RDP, AI of RDP, DDI were 0.70, 0.79, 0.77, 0.80, 0.78, 0.81, respectively. The accuracy of optimized CADD using all features after SFFS was 0.91. We developed the CADD

  13. Helping patients make better decisions: how to apply behavioral economics in clinical practice

    Directory of Open Access Journals (Sweden)

    Courtney MR

    2014-10-01

    Full Text Available Maureen Reni Courtney,1 Christy Spivey,2 Kathy M Daniel1 1College of Nursing, 2College of Business, University of Texas at Arlington, Arlington, TX, USA  Abstract: Clinicians are committed to effectively educating patients and helping them to make sound decisions concerning their own health care. However, how do clinicians determine what is effective education? How do they present information clearly and in a manner that patients understand and can use to make informed decisions? Behavioral economics (BE is a subfield of economics that can assist clinicians to better understand how individuals actually make decisions. BE research can help guide interactions with patients so that information is presented and discussed in a more deliberate and impactful way. We can be more effective providers of care when we understand the factors that influence how our patients make decisions, factors of which we may have been largely unaware. BE research that focuses on health care and medical decision making is becoming more widely known, and what has been reported suggests that BE interventions can be effective in the medical realm. The purpose of this article is to provide clinicians with an overview of BE decision science and derived practice strategies to promote more effective behavior change in patients.Keywords: nursing, message framing, defaults, incentives, social norms, commitment devices, health care

  14. Future perspectives toward the early definition of a multivariate decision-support scheme employed in clinical decision making for senior citizens.

    Science.gov (United States)

    Frantzidis, Christos A; Gilou, Sotiria; Billis, Antonis; Karagianni, Maria; Bratsas, Charalampos D; Bamidis, Panagiotis

    2016-03-01

    Recent neuroscientific studies focused on the identification of pathological neurophysiological patterns (emotions, geriatric depression, memory impairment and sleep disturbances) through computerised clinical decision-support systems. Almost all these research attempts employed either resting-state condition (e.g. eyes-closed) or event-related potentials extracted during a cognitive task known to be affected by the disease under consideration. This Letter reviews existing data mining techniques and aims to enhance their robustness by proposing a holistic decision framework dealing with comorbidities and early symptoms' identification, while it could be applied in realistic occasions. Multivariate features are elicited and fused in order to be compared with average activities characteristic of each neuropathology group. A proposed model of the specific cognitive function which may be based on previous findings (a priori information) and/or validated by current experimental data should be then formed. So, the proposed scheme facilitates the early identification and prevention of neurodegenerative phenomena. Neurophysiological semantic annotation is hypothesised to enhance the importance of the proposed framework in facilitating the personalised healthcare of the information society and medical informatics research community. PMID:27222732

  15. Decisions to withhold diagnostic investigations in nursing home patients with a clinical suspicion of venous thromboembolism.

    Directory of Open Access Journals (Sweden)

    Henrike J Schouten

    Full Text Available This study aimed to gather insights in physicians' considerations for decisions to either refer for- or to withhold additional diagnostic investigations in nursing home patients with a suspicion of venous thromboembolism.Our study was nested in an observational study on diagnostic strategies for suspected venous thromboembolism in nursing home patients. Patient characteristics, bleeding-complications and mortality were related to the decision to withhold investigations. For a better understanding of the physicians' decisions, 21 individual face-to-face in-depth interviews were performed and analysed using the grounded theory approach.Referal for additional diagnostic investigations was forgone in 126/322 (39.1% patients with an indication for diagnostic work-up. 'Blind' anticoagulant treatment was initiated in 95 (75.4% of these patients. The 3 month mortality rates were higher for patients in whom investigations were withheld than in the referred patients, irrespective of anticoagulant treatment (odds ratio 2.45; 95% confidence interval 1.40 to 4.29 but when adjusted for the probability of being referred (i.e. the propensity score, there was no relation of non-diagnosis decisions to mortality (odds ratio 1.75; 0.98 to 3.11. In their decisions to forgo diagnostic investigations, physicians incorporated the estimated relative impact of the potential disease; the potential net-benefits of diagnostic investigations and whether performing investigations agreed with established management goals in advance care planning.Referral for additional diagnostic investigations is withheld in almost 40% of Dutch nursing home patients with suspected venous thromboembolism and an indication for diagnostic work-up. We propose that, given the complexity of these decisions and the uncertainty regarding their indirect effects on patient outcome, more attention should be focused on the decision to either use or withhold additional diagnostic tests.

  16. Impact of Nonvascular Thoracic MR Imaging on the Clinical Decision Making of Thoracic Surgeons: A 2-year Prospective Study.

    Science.gov (United States)

    Ackman, Jeanne B; Gaissert, Henning A; Lanuti, Michael; Digumarthy, Subba R; Shepard, Jo-Anne O; Halpern, Elkan F; Wright, Cameron D

    2016-08-01

    Purpose To determine the impact of nonvascular thoracic magnetic resonance (MR) imaging on the clinical decision making and diagnostic certainty of thoracic surgeons. Materials and Methods Seven thoracic surgeons at Massachusetts General Hospital, an academic quaternary referral hospital, participated in this 2-year, prospective, institution review board-approved, HIPAA-compliant pre- and post-MR imaging survey study after completing a one-time demographic survey. Between July 16, 2013, and July 13, 2015, each time a thoracic surgeon ordered a nonvascular thoracic MR imaging study via radiology order entry, he or she was sent a link to the pre-test survey that ascertained the clinical rationale for MR imaging, the clinical management plan if MR imaging was not an option, and pre-test diagnostic certainty. Upon completion of the MR imaging report, the surgeon was sent a link to the post-test survey assessing if/how MR imaging changed clinical management, the surgeon's comfort with the clinical management plan, and post-test diagnostic certainty. Data were analyzed with Student t, Wilcoxon, and McNemar tests. Results A total of 99 pre- and post-test surveys were completed. Most MR imaging studies (64 of 99 [65%]) were requested because of indeterminate computed tomographic findings. The use of MR imaging significantly reduced the number of planned surgical interventions (P management plan in 95% (94 of 99) of cases. Increased diagnostic certainty as a result of MR imaging was highly significant (P < .0001). In 21% (21 of 99) of cases, definitive MR imaging results warranted no further follow-up or clinical care. Conclusion In appropriate cases, assessment with nonvascular thoracic MR imaging substantially affects the clinical decision making and diagnostic certainty of thoracic surgeons. (©) RSNA, 2016 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on May 2, 2016

  17. Influence of the sFlt-1/PlGF Ratio on Clinical Decision-Making in Women with Suspected Preeclampsia

    Science.gov (United States)

    Klein, Evelyn; Schlembach, Dietmar; Ramoni, Angela; Langer, Elena; Bahlmann, Franz; Grill, Sabine; Schaffenrath, Helene; van der Does, Reinhard; Messinger, Diethelm; Verhagen-Kamerbeek, Wilma D. J.; Reim, Manfred; Hund, Martin; Stepan, Holger

    2016-01-01

    Objective To evaluate the influence of the soluble fms-like tyrosine kinase 1/placental growth factor ratio in physicians’ decision making in pregnant women with signs and symptoms of preeclampsia in routine clinical practice. Methods A multicenter, prospective, open, non-interventional study enrolled pregnant women presenting with preeclampsia signs and symptoms in several European perinatal care centers. Before the soluble fms-like tyrosine kinase 1/placental growth factor ratio result was known, physicians documented intended clinical procedures using an iPad® application (data locked/time stamped). After the result was available, clinical decisions were confirmed or revised and documented. An independent adjudication committee evaluated the appropriateness of decisions based on maternal/fetal outcomes. Clinician decision making with regard to hospitalization was the primary outcome. Results In 16.9% of mothers (20/118) the hospitalization decision was changed after knowledge of the ratio. In 13 women (11.0%), the initial decision to hospitalize was changed to no hospitalization. In seven women (5.9%) the revised decision was hospitalization. All revised decisions were considered appropriate by the panel of adjudicators (McNemar test; p preeclampsia. This is the first study to demonstrate the impact of angiogenic biomarkers on decision making in a routine clinical practice. PMID:27243815

  18. Health system re-engineering: a CPRS economic decision model.

    OpenAIRE

    Diehl, M.

    1995-01-01

    The fundamental problem with the health care delivery system remains too little health delivered for too great a cost. Information essential to sound clinical and administrative decision making is too frequently missing at the time and place of decision. Automated systems offer opportunities both to improve health and to reduce cost through effective and efficient information management. Information systems are the enabling technology for those business practice changes which improve the bene...

  19. Attitudes towards Prosthodontic Clinical Decision-Making for Edentulous Patients among South West Deanery Dental Foundation Year One Dentists

    Directory of Open Access Journals (Sweden)

    Andrew Barber

    2016-05-01

    Full Text Available The aim of this study was to describe Dental Foundation year one dentists’ attitudes towards prosthodontic decision making for edentulous patients, and identify whether there are gender differences in these attitudes. All South West Deanery trainees were invited to take part in the study between May and June 2011 and a previously piloted questionnaire was administered to the trainees by their training programme directors. The questionnaire posed questions based upon a clinical scenario of discussing treatment options with patients. Seventy-two questionnaires were used in the analysis (91% overall response rate. Trainees perceived their own values to be less important than the patient’s values (p < 0.001 in decision making, but similar to the patient’s friend’s/relative’s values (p = 0.1. In addition, the trainees perceived the patient’s values to be less important than their friend’s/relatives (p < 0.001. Sixty-six per cent of trainees acknowledged an influence from their own personal values on their presentation of material to patients who are in the process of choosing among different treatment options, and 87% thought their edentulous patients were satisfied with the decision making process when choosing among different treatment options. Fifty-eight per cent of trainees supported a strategy of negotiation between patients and clinicians (shared decision making. There was no strong evidence to suggest gender had an influence on the attitudes towards decision making. The finding of a consensus towards shared decision making in the attitudes of trainees, and no gender differences is encouraging and is supportive of UK dental schools’ ability to foster ethical and professional values among dentists.

  20. Clinical value of measurement of regional brain function with inhalation of 15O labeled gas synthesized with automated labeled gas production system

    International Nuclear Information System (INIS)

    In order to examine the clinical value of positron emission tomography (PET), we measured cerebral perfusion and oxygen metabolism using oxygen-15 labeled gas (O2, CO2, CO) produced by small cyclotron and the automated synthesis system (AMGS 01). PET study was carried out using oxygen-15 continuous inhalation technique in 61 cases of various neurological diseases including cerebrovascular disease (39 cases), dementia (6 cases), brain tumor (3 cases) and other neurological diseases (13 cases). In all cases, the labeled gas was produced and delivered in a stable condition. Functional images of regional cerebral blood flow (CBF), oxygen extraction fraction (OEF), cerebral metabolic rate for oxygen (CMRO2), and cerebral blood volume (CBV) were calculated according to the oxygen-15 steady-state model. Visual interpretation of these functional images showed abnormal findings in 74 % (CBF images), 30 % (OEF images), 79 % (CMRO2 images) and 10 % (CBV images) of the total cases. Overall assessment for the clinical usefulness of this method was determined as follows: 28 % as highly useful, 41 % as useful, 31 % as fairly useful. No adverse reaction was observed in this clinical trial. In conclusion, the automated synthesis system provided a stable delivery of oxygen-15 gas, and PET measurement of cerebral blood flow and oxygen metabolism is a valuable technique not only for clinical diagnosis but also for understanding pathophysiology of various neurological diseases. (author)

  1. A structured process to develop scenarios for use in evaluation of an evidence-based approach in clinical decision making

    Directory of Open Access Journals (Sweden)

    Manns PJ

    2012-11-01

    Full Text Available Patricia J Manns, Johanna DarrahDepartment of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, CanadaBackground and purpose: Scenarios are used as the basis from which to evaluate the use of the components of evidence-based practice in decision making, yet there are few examples of a standardized process of scenario writing. The aim of this paper is to describe a step-by-step scenario writing method used in the context of the authors’ curriculum research study.Methods: Scenario writing teams included one physical therapy clinician and one academic staff member. There were four steps in the scenario development process: (1 identify prevalent condition and brainstorm interventions; (2 literature search; (3 develop scenario framework; and (4 write scenario.Results: Scenarios focused only on interventions, not diagnostic or prognostic problems. The process led to two types of scenarios – ones that provided an intervention with strong research evidence and others where the intervention had weak evidence to support its use. The end product of the process was a scenario that incorporates aspects of evidence-based decision making and can be used as the basis for evaluation.Conclusion: The use of scenarios has been very helpful to capture therapists’ reasoning processes. The scenario development process was applied in an education context as part of a final evaluation of graduating clinical physical therapy students.Keywords: physical therapists, clinical decision making, evaluation, curriculum

  2. Automated Preferences Elicitation

    Czech Academy of Sciences Publication Activity Database

    Kárný, Miroslav; Guy, Tatiana Valentine

    Prague : Institute of Information Theory and Automation, 2011, s. 20-25. ISBN 978-80-903834-6-3. [The 2nd International Workshop od Decision Making with Multiple Imperfect Decision Makers. Held in Conjunction with the 25th Annual Conference on Neural Information Processing Systems (NIPS 2011). Sierra Nevada (ES), 16.12.2011-16.12.2011] R&D Projects: GA MŠk 1M0572; GA ČR GA102/08/0567 Institutional research plan: CEZ:AV0Z10750506 Keywords : elicitation * decision making * Bayesian decision making * fully probabilistic design Subject RIV: BB - Applied Statistics, Operational Research http://library.utia.cas.cz/separaty/2011/AS/karny-automated preferences elicitation.pdf

  3. Attitudes of Oncologists, Oncology Nurses, and Patients from a Women's Clinic Regarding Medical Decision Making for Older and Younger Breast Cancer Patients.

    Science.gov (United States)

    Beisecker, Analee E.; And Others

    1994-01-01

    Administered Beisecker Locus of Authority in Decision Making: Breast Cancer survey to 67 oncologists, 94 oncology nurses, and 288 patients from women's clinic. All groups believed that physicians should have dominant role in decision making. Nurses felt that patients should have more input than patients or physicians felt they should. Physicians…

  4. A clinical decision support system for integrating tuberculosis and HIV care in Kenya: a human-centered design approach.

    Directory of Open Access Journals (Sweden)

    Caricia Catalani

    Full Text Available With the aim of integrating HIV and tuberculosis care in rural Kenya, a team of researchers, clinicians, and technologists used the human-centered design approach to facilitate design, development, and deployment processes of new patient-specific TB clinical decision support system for medical providers. In Kenya, approximately 1.6 million people are living with HIV and have a 20-times higher risk of dying of tuberculosis. Although tuberculosis prevention and treatment medication is widely available, proven to save lives, and prioritized by the World Health Organization, ensuring that it reaches the most vulnerable communities remains challenging. Human-centered design, used in the fields of industrial design and information technology for decades, is an approach to improving the effectiveness and impact of innovations that has been scarcely used in the health field. Using this approach, our team followed a 3-step process, involving mixed methods assessment to (1 understand the situation through the collection and analysis of site observation sessions and key informant interviews; (2 develop a new clinical decision support system through iterative prototyping, end-user engagement, and usability testing; and, (3 implement and evaluate the system across 24 clinics in rural West Kenya. Through the application of this approach, we found that human-centered design facilitated the process of digital innovation in a complex and resource-constrained context.

  5. A clinical decision support system for integrating tuberculosis and HIV care in Kenya: a human-centered design approach.

    Science.gov (United States)

    Catalani, Caricia; Green, Eric; Owiti, Philip; Keny, Aggrey; Diero, Lameck; Yeung, Ada; Israelski, Dennis; Biondich, Paul

    2014-01-01

    With the aim of integrating HIV and tuberculosis care in rural Kenya, a team of researchers, clinicians, and technologists used the human-centered design approach to facilitate design, development, and deployment processes of new patient-specific TB clinical decision support system for medical providers. In Kenya, approximately 1.6 million people are living with HIV and have a 20-times higher risk of dying of tuberculosis. Although tuberculosis prevention and treatment medication is widely available, proven to save lives, and prioritized by the World Health Organization, ensuring that it reaches the most vulnerable communities remains challenging. Human-centered design, used in the fields of industrial design and information technology for decades, is an approach to improving the effectiveness and impact of innovations that has been scarcely used in the health field. Using this approach, our team followed a 3-step process, involving mixed methods assessment to (1) understand the situation through the collection and analysis of site observation sessions and key informant interviews; (2) develop a new clinical decision support system through iterative prototyping, end-user engagement, and usability testing; and, (3) implement and evaluate the system across 24 clinics in rural West Kenya. Through the application of this approach, we found that human-centered design facilitated the process of digital innovation in a complex and resource-constrained context. PMID:25170939

  6. Making Evidence-based Decisions in the Clinical Practice of Integrative Medicine

    Institute of Scientific and Technical Information of China (English)

    XU Hao; CHEN Ke-ji

    2010-01-01

    @@ In 1948.the first clinical paper adopting the protocol of randomized and controlled design was published in British Medical Journal by Bradford Hill, a noted British biostatistician, who introduced rigorous theory of mathematical statistics into clinical design the first time and successfully evaluated the therapeutic effect of streptomycin on tuberculosis(1).

  7. Intention to adopt clinical decision support systems in a developing country: effect of Physician’s perceived professional autonomy, involvement and belief: a cross-sectional study

    OpenAIRE

    Sambasivan Murali; Esmaeilzadeh Pouyan; Kumar Naresh; Nezakati Hossein

    2012-01-01

    Abstract Background Computer-based clinical decision support systems (CDSS) are regarded as a key element to enhance decision-making in a healthcare environment to improve the quality of medical care delivery. The concern of having new CDSS unused is still one of the biggest issues in developing countries for the developers and implementers of clinical IT systems. The main objectives of this study are to determine whether (1) the physician’s perceived professional autonomy, (2) involvement in...

  8. Perspective: The Challenge of Clinical Decision-Making for Drug Treatment in Older People. The Role of Multidimensional Assessment and Prognosis

    OpenAIRE

    Pilotto, Alberto; Sancarlo, Daniele; Daragjati, Julia; Panza, Francesco

    2015-01-01

    A complex decision path with a careful evaluation of the risk–benefit ratio is mandatory for drug treatment in advanced age. Enrollment biases in randomized clinical trials (RCTs) cause an under-representation of older individuals. In high-risk frail older subjects, the lack of RCTs makes clinical decision-making particularly difficult. Frail individuals are markedly susceptible to adverse drug reactions, and frailty may result in reduced treatment efficacy. Life expectancy should be included...

  9. The Manufacture of Low-Dose Oral Solid Dosage Form to Support Early Clinical Studies Using an Automated Micro-Filing System

    OpenAIRE

    Bi, Mingda; Sun, Changquan Calvin; Alvarez, Francisco; Alvarez-Nunez, Fernando

    2010-01-01

    Automated powder dispensing systems enable supplying early clinical studies using drug-in-capsule approach, which is material sparing and requires a minimum amount of resources. However, the inability of accurately filling the capsule with a small amount, e.g., several micrograms, of drug limits the use of these systems for potent drugs. We demonstrate that formulated powder blends can be used to successfully fill capsules containing 5 μg to 5 mg of drug with adequate content uniformity. Effe...

  10. Description, evaluation and clinical decision making according to various fetal heart rate patterns. Inter-observer and regional variability

    DEFF Research Database (Denmark)

    Lidegaard, O; Bøttcher, L M; Weber, Tom

    1992-01-01

    At 10 Danish obstetrical departments, 116 residents (42 senior and 74 junior) participated in a study to assess inter-observer and regional variability in the description and evaluation of and clinical decision regarding 11 fetal heart rate patterns. The 11 traces included normal as well as...... changes as indicative of less serious fetal stress than did their junior colleagues, explaining why junior residents 30% more frequently than their older colleagues found an indication for Cesarean section. Relatively low regional inter-observer agreement scores were primarily due to low agreement between...

  11. Professional autonomy in 21st century healthcare: Nurses' accounts of clinical decision-making

    DEFF Research Database (Denmark)

    Traynor, Michael; Boland, Maggie; Buus, Niels

    2010-01-01

    Autonomy in decision-making has traditionally been described as a feature of professional work, however the work of healthcare professionals has been seen as steadily encroached upon by State and managerialist forces. Nursing has faced particular problems in establishing itself as a credible...... profession for reasons including history, gender and a traditional subservience to medicine. This paper reports on a focus group study of UK nurses participating in post-qualifying professional development in 2008. Three groups of nurses in different specialist areas comprised a total of 26 participants. The...... study uses accounts of decision-making to gain insight into contemporary professional nursing. The study also aims to explore the usefulness of a theory of professional work set out by Jamous and Peloille (1970). The analysis draws on notions of interpretive repertoires and elements of narrative...

  12. A UMLS-based knowledge acquisition tool for rule-based clinical decision support system development.

    OpenAIRE

    Achour, Soumeya,; Dojat, Michel; Rieux, Claire; Bierling, Philippe; Lepage, Eric

    2001-01-01

    International audience Decision support systems in the medical field have to be easily modified by medical experts themselves. The authors have designed a knowledge acquisition tool to facilitate the creation and maintenance of a knowledge base by the domain expert and its sharing and reuse by other institutions. The Unified Medical Language System (UMLS) contains the domain entities and constitutes the relations repository from which the expert builds, through a specific browser, the expl...

  13. The process of development of a prioritization tool for a clinical decision support build within a computerized provider order entry system: Experiences from St Luke's Health System.

    Science.gov (United States)

    Wolf, Matthew; Miller, Suzanne; DeJong, Doug; House, John A; Dirks, Carl; Beasley, Brent

    2016-09-01

    To establish a process for the development of a prioritization tool for a clinical decision support build within a computerized provider order entry system and concurrently to prioritize alerts for Saint Luke's Health System. The process of prioritizing clinical decision support alerts included (a) consensus sessions to establish a prioritization process and identify clinical decision support alerts through a modified Delphi process and (b) a clinical decision support survey to validate the results. All members of our health system's physician quality organization, Saint Luke's Care as well as clinicians, administrators, and pharmacy staff throughout Saint Luke's Health System, were invited to participate in this confidential survey. The consensus sessions yielded a prioritization process through alert contextualization and associated Likert-type scales. Utilizing this process, the clinical decision support survey polled the opinions of 850 clinicians with a 64.7 percent response rate. Three of the top rated alerts were approved for the pre-implementation build at Saint Luke's Health System: Acute Myocardial Infarction Core Measure Sets, Deep Vein Thrombosis Prophylaxis within 4 h, and Criteria for Sepsis. This study establishes a process for developing a prioritization tool for a clinical decision support build within a computerized provider order entry system that may be applicable to similar institutions. PMID:25814483

  14. Description, evaluation and clinical decision making according to various fetal heart rate patterns. Inter-observer and regional variability

    DEFF Research Database (Denmark)

    Lidegaard, O; Bøttcher, L M; Weber, Tom

    1992-01-01

    departments, especially between departments far apart. It is concluded that we still need a scientific clarification of which specific heart rate changes are the best predictors of fetal stress. Artificial intelligence programs for interpreting fetal cardiotocograms and ECG signals constitute one promising......At 10 Danish obstetrical departments, 116 residents (42 senior and 74 junior) participated in a study to assess inter-observer and regional variability in the description and evaluation of and clinical decision regarding 11 fetal heart rate patterns. The 11 traces included normal as well as...... pathological patterns, and normal as well as clinically asphyxiated babies. Five antepartum and six intrapartum patterns were included. A total of 1,276 descriptions and evaluations were obtained. The degree of agreement in description of fetal heart rate changes was high regarding the baseline and the...

  15. Evaluating the value of a web-based natural medicine clinical decision tool at an academic medical center

    Directory of Open Access Journals (Sweden)

    Karpa Kelly

    2011-10-01

    Full Text Available Abstract Background Consumer use of herbal and natural products (H/NP is increasing, yet physicians are often unprepared to provide guidance due to lack of educational training. This knowledge deficit may place consumers at risk of clinical complications. We wished to evaluate the impact that a natural medicine clinical decision tool has on faculty attitudes, practice experiences, and needs with respect to H/NP. Methods All physicians and clinical staff (nurse practitioners, physicians assistants (n = 532 in departments of Pediatrics, Family and Community Medicine, and Internal Medicine at our medical center were invited to complete 2 electronic surveys. The first survey was completed immediately before access to a H/NP clinical-decision tool was obtained; the second survey was completed the following year. Results Responses were obtained from 89 of 532 practitioners (16.7% on the first survey and 87 of 535 (16.3% clinicians on the second survey. Attitudes towards H/NP varied with gender, age, time in practice, and training. At baseline, before having an evidence-based resource available, nearly half the respondents indicated that they rarely or never ask about H/NP when taking a patient medication history. The majority of these respondents (81% indicated that they would like to learn more about H/NP, but 72% admitted difficulty finding evidence-based information. After implementing the H/NP tool, 63% of database-user respondents indicated that they now ask patients about H/NP when taking a drug history. Compared to results from the baseline survey, respondents who used the database indicated that the tool significantly increased their ability to find reliable H/NP information (P Conclusions Our results demonstrate healthcare provider knowledge and confidence with H/NP can be improved without costly and time-consuming formal H/NP curricula. Yet, it will be challenging to make providers aware of such resources.

  16. Clinical evaluation and surgical decision making for patients with lumbar discogenic pain and facet syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Tessitore, Enrico, E-mail: enrico.tessitore@hcuge.ch [Neurosurgical Unit, Geneva University Hospitals, Faculty of Medicine, University of Geneva (Switzerland); Molliqaj, Granit, E-mail: granitmolliqaj@gmail.com [Neurosurgical Unit, Geneva University Hospitals, Faculty of Medicine, University of Geneva (Switzerland); Schatlo, Bawarjan, E-mail: schatlo@gmail.com [Department of Neurosurgery, Georg-August University, University of Medicine Gottingen, 37075 Gottingen (Germany); Schaller, Karl, E-mail: karl.schaller@hcuge.ch [Neurosurgical Unit, Geneva University Hospitals, Faculty of Medicine, University of Geneva (Switzerland)

    2015-05-15

    In industrialized countries, more than two thirds of the population suffers from low back pain (LBP) in their lifetime. LBP associated with lumbar disc herniation, stenosis, and instability is a well-known and documented entity. On the other hand, the lumbar discogenic pain and facet syndrome are difficult to be clearly identified, and they are not always detectable by imaging. This article describes the causes of these painful syndromes, which are typically without radicular component, explains the modern diagnostic procedures, and provides guidelines for surgical decision making.

  17. Clinical evaluation and surgical decision making for patients with lumbar discogenic pain and facet syndrome

    International Nuclear Information System (INIS)

    In industrialized countries, more than two thirds of the population suffers from low back pain (LBP) in their lifetime. LBP associated with lumbar disc herniation, stenosis, and instability is a well-known and documented entity. On the other hand, the lumbar discogenic pain and facet syndrome are difficult to be clearly identified, and they are not always detectable by imaging. This article describes the causes of these painful syndromes, which are typically without radicular component, explains the modern diagnostic procedures, and provides guidelines for surgical decision making

  18. Development and validation of a tool to measure self-confidence and anxiety in nursing students during clinical decision making.

    Science.gov (United States)

    White, Krista A

    2014-01-01

    Clinical decision making (CDM) is a cornerstone skill for nurses. Self-confidence and anxiety affect the learning and adeptness of CDM. This study aimed to develop and test a quantitative tool to assess undergraduate nursing students' self-confidence and anxiety during CDM. The 27-item Nursing Anxiety and Self-Confidence with Clinical Decision Making (NASC-CDM) scale is a 6-point, Likert-type tool with two subscales. Two samples of prelicensure associate and baccalaureate nursing students participated in the pilot (n = 303) and main testing (n = 242) phases of the study. Construct validity assessment, using exploratory factor analysis, produced a stable three-dimensional scale. Convergent validity assessment produced positive, moderate, and statistically significant correlations of the tool sub-scales with two existing instruments. Internal consistency reliability was assessed for each subscale (self-confidence, α = .97; anxiety, α = .96). The NASC-CDM scale may be a useful assessment tool for nurse educators to help novice clinicians improve CDM skills. PMID:24256004

  19. A clinical rules taxonomy for the implementation of a computerized physician order entry (CPOE) system.

    OpenAIRE

    Wang, Jerome K.; Shabot, M. Michael; Duncan, Raymond G.; Polaschek, Jeanette X.; Jones, Douglas T.

    2002-01-01

    Many of the benefits of computerized physician order entry (CPOE) stem from its ability to support medical decision-making and error-reduction during patient care. This automated "intelligence" is typically represented by a network of rules. We describe a taxonomic representation of clinical decision-support rules in the context of developing and implementing a de novo CPOE and decision-support system. In our experience, this clinical rules taxonomy facilitated our implementation goals in the...

  20. Variations in clinical decision-making between cardiologists and cardiac surgeons; a case for management by multidisciplinary teams?

    Directory of Open Access Journals (Sweden)

    Walker A

    2006-03-01

    Full Text Available Abstract Objective To assess variations in decisions to revascularise patients with coronary heart disease between general cardiologists, interventional cardiologists and cardiac surgeons Design Six cases of coronary heart disease were presented at an open meeting in a standard format including clinical details which might influence the decision to revascularise. Clinicians (n = 53 were then asked to vote using an anonymous electronic system for one of 5 treatment options: medical, surgical (CABG, percutaneous coronary intervention (PCI or initially medical proceeding to revascularisation if symptoms dictated. Each case was then discussed in an open forum following which clinicians were asked to revote. Differences in treatment preference were compared by chi squared test and agreement between groups and between voting rounds compared using Kappa. Results Surgeons were more likely to choose surgery as a form of treatment (p = 0.034 while interventional cardiologists were more likely to choose PCI (p = 0.056. There were no significant differences between non-interventional and interventional cardiologists (p = 0.13 in their choice of treatment. There was poor agreement between all clinicians in the first round of voting (Kappa 0.26 but this improved to a moderate level of agreement after open discussion for the second vote (Kappa 0.44. The level of agreement among surgeons (0.15 was less than that for cardiologists (0.34 in Round 1, but was similar in Round 2 (0.45 and 0.45 respectively Conclusion In this case series, there was poor agreement between cardiac clinical specialists in the choice of treatment offered to patients. Open discussion appeared to improve agreement. These results would support the need for decisions to revascularise to be made by a multidisciplinary panel.

  1. An HL7-CDA wrapper for facilitating semantic interoperability to rule-based Clinical Decision Support Systems.

    Science.gov (United States)

    Sáez, Carlos; Bresó, Adrián; Vicente, Javier; Robles, Montserrat; García-Gómez, Juan Miguel

    2013-03-01

    The success of Clinical Decision Support Systems (CDSS) greatly depends on its capability of being integrated in Health Information Systems (HIS). Several proposals have been published up to date to permit CDSS gathering patient data from HIS. Some base the CDSS data input on the HL7 reference model, however, they are tailored to specific CDSS or clinical guidelines technologies, or do not focus on standardizing the CDSS resultant knowledge. We propose a solution for facilitating semantic interoperability to rule-based CDSS focusing on standardized input and output documents conforming an HL7-CDA wrapper. We define the HL7-CDA restrictions in a HL7-CDA implementation guide. Patient data and rule inference results are mapped respectively to and from the CDSS by means of a binding method based on an XML binding file. As an independent clinical document, the results of a CDSS can present clinical and legal validity. The proposed solution is being applied in a CDSS for providing patient-specific recommendations for the care management of outpatients with diabetes mellitus. PMID:23199936

  2. Interrelation between orthodontics and phonoaudiology in the clinical decision-making of individuals with mouth breathing

    Directory of Open Access Journals (Sweden)

    Rúbia Vezaro Vanz

    2012-06-01

    Full Text Available OBJECTIVE: The purpose of this study was to investigate the decision making of orthodontists of Passo Fundo district - Rio Grande do Sul (RS, Brazil, in the Orthodontics/Speech Therapy interdisciplinary treatment of mouth breathing individuals. METHODS: The present study is a quantitative approach and the design is descriptive, using as instrument data collection of a questionnaire sent to 22 orthodontists practicing in the above-mentioned district. The project was approved the the Ethics in Research Committee and all individuals signed a free informed consent. RESULTS: All professionals considered the inter-relation between Orthodontics and Speech Therapy necessary, but divergences were found in situations where a associated therapy may exist, considering that 54.5% trust the inter-relation to develop aspects associated to language, orofacial motricity and habits. In cases of associated treatment, the results obtained were considered satisfactory by 73.7% of professionals, even though they consider that only 6 to 20% of their patients collaborate with treatment. CONCLUSION: In relation to decision-making in treatment of mouth breathing individuals, the orthodontists in Passo Fundo/RS agree that there is need for speech therapy. The full vision of the individual in a multidisciplinary team is of fundamental importance in the treatment of patients with mouth breathing syndrome.

  3. Impact of Health Information Exchange on Emergency Medicine Clinical Decision Making

    Directory of Open Access Journals (Sweden)

    Bradley D. Gordon

    2015-12-01

    Full Text Available Introduction: The objective of the study was to understand the immediate utility of health information exchange (HIE on emergency department (ED providers by interviewing them shortly after the information was retrieved. Prior studies of physician perceptions regarding HIE have only been performed outside of the care environment. Methods: Trained research assistants interviewed resident physicians, physician assistants and attending physicians using a semi-structured questionnaire within two hours of making a HIE request. The responses were recorded, then transcribed for qualitative analysis. The transcribed interviews were analyzed for emerging qualitative themes. Results: We analyzed 40 interviews obtained from 29 providers. Primary qualitative themes discovered included the following: drivers for requests for outside information; the importance of unexpected information; historical lab values as reference points; providing context when determining whether to admit or discharge a patient; the importance of information in refining disposition; improved confidence of provider; and changes in decisions for diagnostic imaging. Conclusion: ED providers are driven to use HIE when they’re missing a known piece of information. This study finds two additional impacts not previously reported. First, providers sometimes find additional unanticipated useful information, supporting a workflow that lowers the threshold to request external information. Second, providers sometimes report utility when no changes to their existing plan are made as their confidence is increased based on external records. Our findings are concordant with previous studies in finding exchanged information is useful to provide context for interpreting lab results, making admission decisions, and prevents repeat diagnostic imaging.

  4. Clinical, pathological and molecular prognostic factors in prostate cancer decision-making process.

    Science.gov (United States)

    Pugliese, Dario; Palermo, Giuseppe; Totaro, Angelo; Bassi, Pier Francesco; Pinto, Francesco

    2016-03-01

    Prostate cancer is the most common urologic neoplasm and the second leading cause of cancer-related death among men in many developed countries. Given the highly heterogeneous behaviour of the disease, there is a great need for prognostic factors, in order to stratify the clinical risk and give the best treatment options to the patient. Clinical factors, such as prostate-specific antigen value and derivatives, and pathological factors, such as stage and Gleason grading, are well kown prognostic factors. Nomograms can provide useful prediction in each clinical sceario. The field of molecular biomarkers is briskly evolving towards personalized medicine. TMPRSS2-ERG fusion, deletion of PTEN ed and gene panels are some of the more extensively explored molecular features in prostate cancer outcome prediction. In the near future, circulating tumour cells, exosomes and microRNAs could give us further, not invasive important tools. PMID:26917215

  5. Computerized clinical decision support systems for primary preventive care: A decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes

    Directory of Open Access Journals (Sweden)

    Wilczynski Nancy L

    2011-08-01

    Full Text Available Abstract Background Computerized clinical decision support systems (CCDSSs are claimed to improve processes and outcomes of primary preventive care (PPC, but their effects, safety, and acceptance must be confirmed. We updated our previous systematic reviews of CCDSSs and integrated a knowledge translation approach in the process. The objective was to review randomized controlled trials (RCTs assessing the effects of CCDSSs for PPC on process of care, patient outcomes, harms, and costs. Methods We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews Database, Inspec, and other databases, as well as reference lists through January 2010. We contacted authors to confirm data or provide additional information. We included RCTs that assessed the effect of a CCDSS for PPC on process of care and patient outcomes compared to care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement if at least 50% of the relevant study outcomes were statistically significantly positive. Results We added 17 new RCTs to our 2005 review for a total of 41 studies. RCT quality improved over time. CCDSSs improved process of care in 25 of 40 (63% RCTs. Cumulative scientifically strong evidence supports the effectiveness of CCDSSs for screening and management of dyslipidaemia in primary care. There is mixed evidence for effectiveness in screening for cancer and mental health conditions, multiple preventive care activities, vaccination, and other preventive care interventions. Fourteen (34% trials assessed patient outcomes, and four (29% reported improvements with the CCDSS. Most trials were not powered to evaluate patient-important outcomes. CCDSS costs and adverse events were reported in only six (15% and two (5% trials, respectively. Information on study duration was often missing, limiting our ability to assess sustainability of CCDSS effects. Conclusions

  6. Impact of a clinical decision model for febrile children at risk for serious bacterial infections at the emergency department: a randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Evelien de Vos-Kerkhof

    Full Text Available To assess the impact of a clinical decision model for febrile children at risk for serious bacterial infections (SBI attending the emergency department (ED.Randomized controlled trial with 439 febrile children, aged 1 month-16 years, attending the pediatric ED of a Dutch university hospital during 2010-2012. Febrile children were randomly assigned to the intervention (clinical decision model; n = 219 or the control group (usual care; n = 220. The clinical decision model included clinical symptoms, vital signs, and C-reactive protein and provided high/low-risks for "pneumonia" and "other SBI". Nurses were guided by the intervention to initiate additional tests for high-risk children. The clinical decision model was evaluated by 1 area-under-the-receiver-operating-characteristic-curve (AUC to indicate discriminative ability and 2 feasibility, to measure nurses' compliance to model recommendations. Primary patient outcome was defined as correct SBI diagnoses. Secondary process outcomes were defined as length of stay; diagnostic tests; antibiotic treatment; hospital admission; revisits and medical costs.The decision model had good discriminative ability for both pneumonia (n = 33; AUC 0.83 (95% CI 0.75-0.90 and other SBI (n = 22; AUC 0.81 (95% CI 0.72-0.90. Compliance to model recommendations was high (86%. No differences in correct SBI determination were observed. Application of the clinical decision model resulted in less full-blood-counts (14% vs. 22%, p-value < 0.05 and more urine-dipstick testing (71% vs. 61%, p-value < 0.05.In contrast to our expectations no substantial impact on patient outcome was perceived. The clinical decision model preserved, however, good discriminatory ability to detect SBI, achieved good compliance among nurses and resulted in a more standardized diagnostic approach towards febrile children, with less full blood-counts and more rightfully urine-dipstick testing.Nederlands Trial Register NTR2381.

  7. Economic comparison of common treatment protocols and J5 vaccination for clinical mastitis in dairy herds using optimized culling decisions.

    Science.gov (United States)

    Kessels, J A; Cha, E; Johnson, S K; Welcome, F L; Kristensen, A R; Gröhn, Y T

    2016-05-01

    This study used an existing dynamic optimization model to compare costs of common treatment protocols and J5 vaccination for clinical mastitis in US dairy herds. Clinical mastitis is an infection of the mammary gland causing major economic losses in dairy herds due to reduced milk production, reduced conception, and increased risk of mortality and culling for infected cows. Treatment protocols were developed to reflect common practices in dairy herds. These included targeted therapy following pathogen identification, and therapy without pathogen identification using a broad-spectrum antimicrobial or treating with the cheapest treatment option. The cost-benefit of J5 vaccination was also estimated. Effects of treatment were accounted for as changes in treatment costs, milk loss due to mastitis, milk discarded due to treatment, and mortality. Following ineffective treatments, secondary decisions included extending the current treatment, alternative treatment, discontinuing treatment, and pathogen identification followed by recommended treatment. Average net returns for treatment protocols and vaccination were generated using an existing dynamic programming model. This model incorporates cow and pathogen characteristics to optimize management decisions to treat, inseminate, or cull cows. Of the treatment protocols where 100% of cows received recommended treatment, pathogen-specific identification followed by recommended therapy yielded the highest average net returns per cow per year. Out of all treatment scenarios, the highest net returns were achieved with selecting the cheapest treatment option and discontinuing treatment, or alternate treatment with a similar spectrum therapy; however, this may not account for the full consequences of giving nonrecommended therapies to cows with clinical mastitis. Vaccination increased average net returns in all scenarios. PMID:26947301

  8. Clinical Decision Making and Outcome in Routine Care for People with Severe Mental Illness (CEDAR: Study protocol

    Directory of Open Access Journals (Sweden)

    Nemes Zoltan

    2010-11-01

    Full Text Available Abstract Background A considerable amount of research has been conducted on clinical decision making (CDM in short-term physical conditions. However, there is a lack of knowledge on CDM and its outcome in long-term illnesses, especially in care for people with severe mental illness. Methods/Design The study entitled "Clinical decision making and outcome in routine care for people with severe mental illness" (CEDAR is carried out in six European countries (Denmark, Germany, Hungary, Italy, Switzerland and UK. First, CEDAR establishes a methodology to assess CDM in people with severe mental illness. Specific instruments are developed (and psychometric properties established to measure CDM style, key elements of CDM in routine care, as well as CDM involvement and satisfaction from patient and therapist perspectives. Second, these instruments are being put to use in a multi-national prospective observational study (bimonthly assessments during a one-year observation period; N = 560. This study investigates the immediate, short- and long-term effect of CDM on crucial dimensions of clinical outcome (symptom level, quality of life, needs by taking into account significant variables moderating the relationship between CDM and outcome. Discussion The results of this study will make possible to delineate quality indicators of CDM, as well as to specify prime areas for further improvement. Ingredients of best practice in CDM in the routine care for people with severe mental illness will be extracted and recommendations formulated. With its explicit focus on the patient role in CDM, CEDAR will also contribute to strengthening the service user perspective. This project will substantially add to improving the practice of CDM in mental health care across Europe. Trial register ISRCTN75841675.

  9. [An expert system of aiding decision making in breast pathology connected to a clinical data base].

    Science.gov (United States)

    Brunet, M; Durrleman, S; Ferber, J; Ganascia, J G; Hacene, K; Hirt, F; Jouniaux, F; Meeus, L

    1987-01-01

    The René Huguenin Cancer Center holds a medical file for each patient which is intended to store and process medical data. Since 1970, we introduced computerization: a development plan was elaborated and simultaneously a statistical software (Clotilde--GSI/CFRO) was selected. Thus, we now have access to a large database, structured according to medical rationale, and utilizable with methods of artificial intelligence towards three objectives: improved data acquisition, decision making and exploitation. The first application was to breast pathology, which represents one of the Center's primary activities. The structure of the data concerning patients is by all criteria part of the medical knowledge. This information needs to be presented as well as processed with a suitable language. To this end, we chose a language-oriented object, Mering II, usable with Apple and IBM 4 micro-computers. This project has already allowed to work out an operational model. PMID:3620732

  10. Skin Disease in the Uninsured: Diagnoses, Management Decisions, and Referral Outcomes of an Urban Free Clinic.

    Science.gov (United States)

    Rosenbaum, Brooke E; Freitas, Derek; Nosal, Sarah C; Meydani, Ahou

    2016-01-01

    An understanding of the burden of skin disease in the uninsured population is needed to address the unique barriers they face to access dermatologic care. We conducted a retrospective chart review of patients seen for skin conditions over three years at the New York City (NYC) Free Clinic, a weekly primary care clinic operated by the NYU School of Medicine and the Institute for Family Health. Main outcomes of this study were descriptive analyses of demographic characteristics, diagnoses, management strategies, and referral outcomes, as well as key factors influencing referral to a dermatologist and referral attendance. Diagnosis was a significant predictor of referral (ptravel distance had no significant association with non-attendance. While demand for dermatologic care by uninsured patients in NYC is high, referral non-attendance remains a substantial barrier to care. PMID:27180711

  11. Real-Time Clinical Decision Support System with Data Stream Mining

    Directory of Open Access Journals (Sweden)

    Yang Zhang

    2012-01-01

    Full Text Available This research aims to describe a new design of data stream mining system that can analyze medical data stream and make real-time prediction. The motivation of the research is due to a growing concern of combining software technology and medical functions for the development of software application that can be used in medical field of chronic disease prognosis and diagnosis, children healthcare, diabetes diagnosis, and so forth. Most of the existing software technologies are case-based data mining systems. They only can analyze finite and structured data set and can only work well in their early years and can hardly meet today's medical requirement. In this paper, we describe a clinical-support-system based data stream mining technology; the design has taken into account all the shortcomings of the existing clinical support systems.

  12. Primary care clinic location decision-making and spatial accessibility for the region of Thessaly

    OpenAIRE

    Yorgos N. Photis; Manetos, Panos

    2008-01-01

    The prospect for establishing a General Clinic at the Thessaly Region was examined. The new facility aimes to provide full medical care by qualified scientists (permanent personnel, shareholders or associates), by experienced, trained and skilled nursing personnel, fully organised with sophisticated technological equipment, in a hospitable and pleasant environment, with easy and fast access. The main aim of this study is the determination of the optimum location for the construction of...

  13. CLINICAL DECISION MAKING IN NURSING CARE: EVIDENCE BASED PRACTICE AND SENIORITY

    OpenAIRE

    Sivasangari Subramaniam; Sotheenathan Krishinan; Revathy U. Thandapani; Hans Van Rostenberghe; Azriani Berahim

    2015-01-01

    In the nursing profession, EBP makes a positive contribution to healthcare outcomes, care delivery, clinical teaching and research. The research objective was to determine the nurses' knowledge, attitude, practice towards EBP and barriers to use EBP in four (4) Government Hospitals in Malaysia, Hospital Universiti Sains Malaysia (HUSM), Hospital Pulau Pinang (HPP), Hospital Sultan Abdul Halim (HSAH) and Hospital Seberang Jaya (HSJ). A cross-sectional study was conducted from January until Dec...

  14. Nurses' Numeracy and Graphical Literacy: Informing Studies of Clinical Decision Support Interfaces.

    Science.gov (United States)

    Lopez, Karen Dunn; Wilkie, Diana J; Yao, Yingwei; Sousa, Vanessa; Febretti, Alessandro; Stifter, Janet; Johnson, Andrew; Keenan, Gail M

    2016-01-01

    We present findings of a comparative study of numeracy and graph literacy in a representative group of 60 practicing nurses. This article focuses on a fundamental concern related to the effectiveness of numeric information displayed in various features in the electronic health record during clinical workflow. Our findings suggest the need to consider numeracy and graph literacy when presenting numerical information as well as the potential for tailoring numeric display types to an individual's cognitive strengths. PMID:26323050

  15. Are nurse and pharmacist independent prescribers making clinically appropriate prescribing decisions? An analysis of consultations

    OpenAIRE

    Latter, Sue; Smith, Alesha; Blenkinsopp, Alison; Nicholls, Peter G.; Little, Paul; Chapman, Stephen

    2012-01-01

    OBJECTIVES: Legislation and health policy enabling nurses and pharmacists to prescribe a comprehensive range of medicines has been in place in the UK since 2006. Our objective was to evaluate the clinical appropriateness of prescribing by these professionals. METHODS: A modified version of the Medication Appropriateness Index (MAI) was used by 10 medical, seven pharmacist and three nurse independent raters to evaluate a sample of 100 audio-recorded consultations in which a medicine was pr...

  16. Home Automation

    OpenAIRE

    Ahmed, Zeeshan

    2010-01-01

    In this paper I briefly discuss the importance of home automation system. Going in to the details I briefly present a real time designed and implemented software and hardware oriented house automation research project, capable of automating house's electricity and providing a security system to detect the presence of unexpected behavior.

  17. Examining perceptions of the usefulness and usability of a mobile-based system for pharmacogenomics clinical decision support: a mixed methods study

    OpenAIRE

    Blagec, Kathrin; Romagnoli, Katrina M.; Boyce, Richard D.; Samwald, Matthias

    2016-01-01

    Background. Pharmacogenomic testing has the potential to improve the safety and efficacy of pharmacotherapy, but clinical application of pharmacogenetic knowledge has remained uncommon. Clinical Decision Support (CDS) systems could help overcome some of the barriers to clinical implementation. The aim of this study was to evaluate the perception and usability of a web- and mobile-enabled CDS system for pharmacogenetics-guided drug therapy–the Medication Safety Code (MSC) system–among potentia...

  18. Developing a Physiotherapy-Specific Preliminary Clinical Decision-Making Tool for Oxygen Titration: A Modified Delphi Study

    Science.gov (United States)

    Duong, Michelle; Bertin, Kendra; Henry, Renee; Singh, Deepti; Timmins, Nolla; Brooks, Dina; Mathur, Sunita

    2014-01-01

    ABSTRACT Purpose: To develop and evaluate a preliminary clinical decision-making tool (CDMT) to assist physiotherapists in titrating oxygen for acutely ill adults in Ontario. Methods: A panel of 14 experienced cardiorespiratory physiotherapists was recruited. Factors relating to oxygen titration were identified using a modified Delphi technique. Four rounds of questionnaires were conducted, during which the goals were to (1) generate factors, (2) reduce factors and debate contentious factors, (3) finalize factors and develop the preliminary CDMT, and (4) evaluate the usability of the tool in a clinical context. Results: The panel reached consensus on a total of 89 factors, which were compiled to create the preliminary CDMT. The global tool reached consensus for sensibility, receiving a mean score of 6/7 on a 7-point Likert-type scale (1=unacceptable; 7=excellent). Five of the nine individual components of evaluation of the tool achieved scores ≥6.0; the remaining four had mean scores between 5.4 and 5.9. Conclusion: This study produced a preliminary CDMT for oxygen titration, which the panel agreed was highly comprehensible and globally sensible. Further research is necessary to evaluate the sensibility and applicability of the tool in a clinical setting. PMID:25125782

  19. Software-controlled, highly automated intrafraction prostate motion correction with intrafraction stereographic targeting: System description and clinical results

    International Nuclear Information System (INIS)

    Purpose: A new system for software-controlled, highly automated correction of intrafraction prostate motion,'' intrafraction stereographic targeting'' (iSGT), is described and evaluated. Methods: At our institute, daily prostate positioning is routinely performed at the start of treatment beam using stereographic targeting (SGT). iSGT was implemented by extension of the SGT software to facilitate fast and accurate intrafraction motion corrections with minimal user interaction. iSGT entails megavoltage (MV) image acquisitions with the first segment of selected IMRT beams, automatic registration of implanted markers, followed by remote couch repositioning to correct for intrafraction motion above a predefined threshold, prior to delivery of the remaining segments. For a group of 120 patients, iSGT with corrections for two nearly lateral beams was evaluated in terms of workload and impact on effective intrafraction displacements in the sagittal plane. Results: SDs of systematic (Σ) and random (σ) displacements relative to the planning CT measured directly after initial SGT setup correction were eff eff eff eff eff eff < 0.7 mm, requiring corrections in 82.4% of the fractions. Because iSGT is highly automated, the extra time added by iSGT is <30 s if a correction is required. Conclusions: Without increasing imaging dose, iSGT successfully reduces intrafraction prostate motion with minimal workload and increase in fraction time. An action level of 2 mm is recommended.

  20. Clinical decision-making tools for exam selection, reporting and dose tracking

    International Nuclear Information System (INIS)

    Although many efforts have been made to reduce the radiation dose associated with individual medical imaging examinations to ''as low as reasonably achievable,'' efforts to ensure such examinations are performed only when medically indicated and appropriate are equally if not more important. Variations in the use of ionizing radiation for medical imaging are concerning, regardless of whether they occur on a local, regional or national basis. Such variations among practices can be reduced with the use of decision support tools at the time of order entry. These tools help reduce radiation exposure among practices through the appropriate use of medical imaging. Similarly, adoption of best practices among imaging facilities can be promoted through tracking the radiation exposure among imaging patients. Practices can benchmark their aggregate radiation exposures for medical imaging through the use of dose index registries. However several variables must be considered when contemplating individual patient dose tracking. The specific dose measures and the variation among them introduced by variations in body habitus must be understood. Moreover the uncertainties in risk estimation from dose metrics related to age, gender and life expectancy must also be taken into account. (orig.)

  1. Clinical decision-making tools for exam selection, reporting and dose tracking

    Energy Technology Data Exchange (ETDEWEB)

    Brink, James A. [Massachusetts General Hospital, Harvard Medical School, Department of Radiology, Boston, MA (United States)

    2014-10-15

    Although many efforts have been made to reduce the radiation dose associated with individual medical imaging examinations to ''as low as reasonably achievable,'' efforts to ensure such examinations are performed only when medically indicated and appropriate are equally if not more important. Variations in the use of ionizing radiation for medical imaging are concerning, regardless of whether they occur on a local, regional or national basis. Such variations among practices can be reduced with the use of decision support tools at the time of order entry. These tools help reduce radiation exposure among practices through the appropriate use of medical imaging. Similarly, adoption of best practices among imaging facilities can be promoted through tracking the radiation exposure among imaging patients. Practices can benchmark their aggregate radiation exposures for medical imaging through the use of dose index registries. However several variables must be considered when contemplating individual patient dose tracking. The specific dose measures and the variation among them introduced by variations in body habitus must be understood. Moreover the uncertainties in risk estimation from dose metrics related to age, gender and life expectancy must also be taken into account. (orig.)

  2. Computerized Clinical Decision Support to Prevent Venous Thromboembolism Among Hospitalized Patients: Proximal Outcomes from a Multiyear Quality Improvement Project.

    Science.gov (United States)

    Amland, Robert C; Dean, Bonnie B; Yu, HsingTing; Ryan, Hugh; Orsund, Timothy; Hackman, Jeffrey L; Roberts, Shauna R

    2015-01-01

    Despite venous thromboembolism (VTE) policy initiatives, gaps exist between guidelines and practice. In response, hospitals implement clinical decision support (CDS) systems to improve VTE prophylaxis. To assess the impact of a VTE CDS on reducing incidence of VTE, this study used a pretest/posttest, longitudinal, cohort design incorporating electronic health record (EHR) data from one urban tertiary and level 1 trauma center, and one suburban hospital. VTE CDS was embedded into the EHR system. The study included 45,046 admissions; 171,753 patient days; and 110 VTE events. The VTE rate declined from 0.954 per 1,000 patient days to 0.434 comparing baseline to full VTE CDS. Compared to baseline, patients benefitting from VTE CDS were 35% less likely to have a VTE. VTE CDS utilization achieved 78.4% patients assessed within 24 hr from admission, 64.0% patients identified at risk, and 47.7% patients at risk for VTE with an initiated VTE interdisciplinary plan of care. CDS systems with embedded algorithms, alerts, and notification capabilities enable physicians at the point of care to utilize guidelines and make impactful decisions to prevent VTE. This study demonstrates a phased-in implementation of VTE CDS as an effective approach toward VTE prevention. Implications for future research and quality improvement are discussed as well. PMID:26151096

  3. An international observational study suggests that artificial intelligence for clinical decision support optimizes anemia management in hemodialysis patients.

    Science.gov (United States)

    Barbieri, Carlo; Molina, Manuel; Ponce, Pedro; Tothova, Monika; Cattinelli, Isabella; Ion Titapiccolo, Jasmine; Mari, Flavio; Amato, Claudia; Leipold, Frank; Wehmeyer, Wolfgang; Stuard, Stefano; Stopper, Andrea; Canaud, Bernard

    2016-08-01

    Managing anemia in hemodialysis patients can be challenging because of competing therapeutic targets and individual variability. Because therapy recommendations provided by a decision support system can benefit both patients and doctors, we evaluated the impact of an artificial intelligence decision support system, the Anemia Control Model (ACM), on anemia outcomes. Based on patient profiles, the ACM was built to recommend suitable erythropoietic-stimulating agent doses. Our retrospective study consisted of a 12-month control phase (standard anemia care), followed by a 12-month observation phase (ACM-guided care) encompassing 752 patients undergoing hemodialysis therapy in 3 NephroCare clinics located in separate countries. The percentage of hemoglobin values on target, the median darbepoetin dose, and individual hemoglobin fluctuation (estimated from the intrapatient hemoglobin standard deviation) were deemed primary outcomes. In the observation phase, median darbepoetin consumption significantly decreased from 0.63 to 0.46 μg/kg/month, whereas on-target hemoglobin values significantly increased from 70.6% to 76.6%, reaching 83.2% when the ACM suggestions were implemented. Moreover, ACM introduction led to a significant decrease in hemoglobin fluctuation (intrapatient standard deviation decreased from 0.95 g/dl to 0.83 g/dl). Thus, ACM support helped improve anemia outcomes of hemodialysis patients, minimizing erythropoietic-stimulating agent use with the potential to reduce the cost of treatment. PMID:27262365

  4. A Novel Clinical Decision Support System Using Improved Adaptive Genetic Algorithm for the Assessment of Fetal Well-Being

    Directory of Open Access Journals (Sweden)

    Sindhu Ravindran

    2015-01-01

    Full Text Available A novel clinical decision support system is proposed in this paper for evaluating the fetal well-being from the cardiotocogram (CTG dataset through an Improved Adaptive Genetic Algorithm (IAGA and Extreme Learning Machine (ELM. IAGA employs a new scaling technique (called sigma scaling to avoid premature convergence and applies adaptive crossover and mutation techniques with masking concepts to enhance population diversity. Also, this search algorithm utilizes three different fitness functions (two single objective fitness functions and multi-objective fitness function to assess its performance. The classification results unfold that promising classification accuracy of 94% is obtained with an optimal feature subset using IAGA. Also, the classification results are compared with those of other Feature Reduction techniques to substantiate its exhaustive search towards the global optimum. Besides, five other benchmark datasets are used to gauge the strength of the proposed IAGA algorithm.

  5. Automated detection of exudates for diabetic retinopathy screening

    International Nuclear Information System (INIS)

    Automated image analysis is being widely sought to reduce the workload required for grading images resulting from diabetic retinopathy screening programmes. The recognition of exudates in retinal images is an important goal for automated analysis since these are one of the indicators that the disease has progressed to a stage requiring referral to an ophthalmologist. Candidate exudates were detected using a multi-scale morphological process. Based on local properties, the likelihoods of a candidate being a member of classes exudate, drusen or background were determined. This leads to a likelihood of the image containing exudates which can be thresholded to create a binary decision. Compared to a clinical reference standard, images containing exudates were detected with sensitivity 95.0% and specificity 84.6% in a test set of 13 219 images of which 300 contained exudates. Depending on requirements, this method could form part of an automated system to detect images showing either any diabetic retinopathy or referable diabetic retinopathy

  6. Automated detection of exudates for diabetic retinopathy screening

    Energy Technology Data Exchange (ETDEWEB)

    Fleming, Alan D [Biomedical Physics, University of Aberdeen, Aberdeen, AB25 2ZD (United Kingdom); Philip, Sam [Diabetes Retinal Screening Service, David Anderson Building, Foresterhill Road, Aberdeen, AB25 2ZP (United Kingdom); Goatman, Keith A [Biomedical Physics, University of Aberdeen, Aberdeen, AB25 2ZD (United Kingdom); Williams, Graeme J [Diabetes Retinal Screening Service, David Anderson Building, Foresterhill Road, Aberdeen, AB25 2ZP (United Kingdom); Olson, John A [Diabetes Retinal Screening Service, David Anderson Building, Foresterhill Road, Aberdeen, AB25 2ZP (United Kingdom); Sharp, Peter F [Biomedical Physics, University of Aberdeen, Aberdeen, AB25 2ZD (United Kingdom)

    2007-12-21

    Automated image analysis is being widely sought to reduce the workload required for grading images resulting from diabetic retinopathy screening programmes. The recognition of exudates in retinal images is an important goal for automated analysis since these are one of the indicators that the disease has progressed to a stage requiring referral to an ophthalmologist. Candidate exudates were detected using a multi-scale morphological process. Based on local properties, the likelihoods of a candidate being a member of classes exudate, drusen or background were determined. This leads to a likelihood of the image containing exudates which can be thresholded to create a binary decision. Compared to a clinical reference standard, images containing exudates were detected with sensitivity 95.0% and specificity 84.6% in a test set of 13 219 images of which 300 contained exudates. Depending on requirements, this method could form part of an automated system to detect images showing either any diabetic retinopathy or referable diabetic retinopathy.

  7. Parameter evaluation and fully-automated radiosynthesis of [11C]harmine for imaging of MAO-A for clinical trials

    International Nuclear Information System (INIS)

    The aim of the present study was the evaluation and automation of the radiosynthesis of [11C]harmine for clinical trials. The following parameters have been investigated: amount of base, precursor concentration, solvent, reaction temperature and time. The optimum reaction conditions were determined to be 2–3 mg/mL precursor activated with 1 eq. 5 M NaOH in DMSO, 80 °C reaction temperature and 2 min reaction time. Under these conditions 6.1±1 GBq (51.0±11% based on [11C]CH3I, corrected for decay) of [11C]harmine (n=72) were obtained. The specific activity was 101.32±28.2 GBq/µmol (at EOS). All quality control parameters were in accordance with the standards for parenteral human application. Due to its reliability and high yields, this fully-automated synthesis method can be used as routine set-up. - Highlights: • Preparation of [11C]harmine on a commercially available synthesizer for the routine application. • High reliability: only 4 out of 72 failed syntheses; 5% due to technical problems. • High yields: 6.1±1 GBq overall yield (EOS). • High specific activities: 101.32±28.2 GBq/µmol

  8. Do computerised clinical decision support systems for prescribing change practice? A systematic review of the literature (1990-2007

    Directory of Open Access Journals (Sweden)

    Williamson Margaret

    2009-08-01

    Full Text Available Abstract Background Computerised clinical decision support systems (CDSSs are used widely to improve quality of care and patient outcomes. This systematic review evaluated the impact of CDSSs in targeting specific aspects of prescribing, namely initiating, monitoring and stopping therapy. We also examined the influence of clinical setting (institutional vs ambulatory care, system- or user-initiation of CDSS, multi-faceted vs stand alone CDSS interventions and clinical target on practice changes in line with the intent of the CDSS. Methods We searched Medline, Embase and PsychINFO for publications from 1990-2007 detailing CDSS prescribing interventions. Pairs of independent reviewers extracted the key features and prescribing outcomes of methodologically adequate studies (experiments and strong quasi-experiments. Results 56 studies met our inclusion criteria, 38 addressing initiating, 23 monitoring and three stopping therapy. At the time of initiating therapy, CDSSs appear to be somewhat more effective after, rather than before, drug selection has occurred (7/12 versus 12/26 studies reporting statistically significant improvements in favour of CDSSs on = 50% of prescribing outcomes reported. CDSSs also appeared to be effective for monitoring therapy, particularly using laboratory test reminders (4/7 studies reporting significant improvements in favour of CDSSs on the majority of prescribing outcomes. None of the studies addressing stopping therapy demonstrated impacts in favour of CDSSs over comparators. The most consistently effective approaches used system-initiated advice to fine-tune existing therapy by making recommendations to improve patient safety, adjust the dose, duration or form of prescribed drugs or increase the laboratory testing rates for patients on long-term therapy. CDSSs appeared to perform better in institutional compared to ambulatory settings and when decision support was initiated automatically by the system as opposed to

  9. Automating HIV Drug Resistance Genotyping with RECall, a Freely Accessible Sequence Analysis Tool

    OpenAIRE

    Woods, Conan K.; Chanson J Brumme; Liu, Tommy F; Chui, Celia K. S.; Chu, Anna L.; Wynhoven, Brian; Hall, Tom A.; Trevino, Christina; Shafer, Robert W; Harrigan, P. Richard

    2012-01-01

    Genotypic HIV drug resistance testing is routinely used to guide clinical decisions. While genotyping methods can be standardized, a slow, labor-intensive, and subjective manual sequence interpretation step is required. We therefore performed external validation of our custom software RECall, a fully automated sequence analysis pipeline. HIV-1 drug resistance genotyping was performed on 981 clinical samples at the Stanford Diagnostic Virology Laboratory. Sequencing trace files were first inte...

  10. Does accountability for reasonableness work? A protocol for a mixed methods study using an audit tool to evaluate the decision-making of clinical commissioning groups in England

    OpenAIRE

    Kieslich, Katharina; Littlejohns, Peter

    2015-01-01

    Introduction Clinical commissioning groups (CCGs) in England are tasked with making difficult decisions on which healthcare services to provide against the background of limited budgets. The question is how to ensure that these decisions are fair and legitimate. Accounts of what constitutes fair and legitimate priority setting in healthcare include Daniels’ and Sabin's accountability for reasonableness (A4R) and Clark's and Weale's framework for the identification of social values. This study...

  11. "Metabolic staging" after major trauma - a guide for clinical decision making?

    Directory of Open Access Journals (Sweden)

    Moore Ernest E

    2010-06-01

    Full Text Available Abstract Metabolic changes after major trauma have a complex underlying pathophysiology. The early posttraumatic stress response is associated with a state of hyperinflammation, with increased oxygen consumption and energy expenditure. This hypercatabolic state must be recognized early and mandates an early nutritional management strategy. A proactive concept of early enteral "immunonutrition" in severely injured patients, is aimed at counterbalancing the negative aspects of hyperinflammation and hypercatabolism in order to reduce the risk of late complications, including infections and posttraumatic organ failure. Recently, the concept of "metabolic staging" has been advocated, which takes into account the distinct inflammatory phases and metabolic phenotypes after major trauma, including the "ischemia/reperfusion phenotype", the "leukocytic phenotype", and the "angiogenic phenotype". The potential clinical impact of metabolic staging, and of an appropriately adapted "metabolic control" and nutritional support, remains to be determined.

  12. Pharmacogenetics Informed Decision Making in Adolescent Psychiatric Treatment: A Clinical Case Report

    Directory of Open Access Journals (Sweden)

    Teri Smith

    2015-02-01

    Full Text Available Advances made in genetic testing and tools applied to pharmacogenetics are increasingly being used to inform clinicians in fields such as oncology, hematology, diabetes (endocrinology, cardiology and expanding into psychiatry by examining the influences of genetics on drug efficacy and metabolism. We present a clinical case example of an adolescent male with anxiety, attention deficit hyperactivity disorder (ADHD and autism spectrum disorder who did not tolerate numerous medications and dosages over several years in attempts to manage his symptoms. Pharmacogenetics testing was performed and DNA results on this individual elucidated the potential pitfalls in medication use because of specific pharmacodynamic and pharmacokinetic differences specifically involving polymorphisms of genes in the cytochrome p450 enzyme system. Future studies and reports are needed to further illustrate and determine the type of individualized medicine approach required to treat individuals based on their specific gene patterns. Growing evidence supports this biological approach for standard of care in psychiatry.

  13. Formal Logic and Flowchart for Diagnosis Validity Verification and Inclusion in Clinical Decision Support Systems

    Science.gov (United States)

    Sosa, M.; Grundel, L.; Simini, F.

    2016-04-01

    Logical reasoning is part of medical practice since its origins. Modern Medicine has included information-intensive tools to refine diagnostics and treatment protocols. We are introducing formal logic teaching in Medical School prior to Clinical Internship, to foster medical practice. Two simple examples (Acute Myocardial Infarction and Diabetes Mellitus) are given in terms of formal logic expression and truth tables. Flowcharts of both diagnostic processes help understand the procedures and to validate them logically. The particularity of medical information is that it is often accompanied by “missing data” which suggests to adapt formal logic to a “three state” logic in the future. Medical Education must include formal logic to understand complex protocols and best practices, prone to mutual interactions.

  14. Tc99m - Dextran Sentinel Node detection: Improvement of clinical decision making in malignant skin lesions

    International Nuclear Information System (INIS)

    Introduction: Preoperative lymphoscintigraphy and sentinel node detection are necessary to perform selective lymphadenectomies for staging purposes in malignant skin lesions. Aim: Our goal was to assess the usefulness of Tc99m-Dextran lymphoscintigraphy and sentinel node detection in the nodal staging of malignant skin lesions. Materials and Methods: Retrospectively an experienced oncologic surgeon defined the nodal staging approach he would have had based on the clinical information excluding only the scintigraphic sentinel node detection result in 44 consecutive patients, 21 men, ages 5 - 79, with melanoma (41), Merkel cell tumor (2) and squamous cell tumor (1). We analyze the changes introduced by the use of sentinel node detection in view of anatomopathological findings and clinical outcome. Results: In 35/44 patients no adenectomy would have been performed. Thus, leaving 3 (+) sentinel nodes and 32 (-) sentinel nodes undetected. One of this 32 patients would have had unnecessary radiotherapy because of unknown nodal status. Two of these 32 patients, with malignant melanoma, had metastasis after 15 and 22 month to 1/16 regional lymph nodes and to the skin close to the original lesion respectively. In two other patients the sentinel node could not be identified by scintigraphy : one had negative pathology of regional lymphadenectomy and the other is healthy 20 month after surgery. In 9/44 patients regional adenectomy would have excised 4 (+) sentinel nodes, 4 (-) sentinel nodes and left 1 (+) sentinel node located in an unexpected lymphatic bed. Conclusion: Preoperative sentinel node location guides the surgeon to a rational, limited lymph node excision avoiding staging errors. Selective adenectomy has less complications thus permitting anatomopathological evaluation even for lower risk patients

  15. Development of a real-time clinical decision support system upon the web mvc-based architecture for prostate cancer treatment

    Directory of Open Access Journals (Sweden)

    Liang Wen-Miin

    2011-03-01

    Full Text Available Abstract Background A real-time clinical decision support system (RTCDSS with interactive diagrams enables clinicians to instantly and efficiently track patients' clinical records (PCRs and improve their quality of clinical care. We propose a RTCDSS to process online clinical informatics from multiple databases for clinical decision making in the treatment of prostate cancer based on Web Model-View-Controller (MVC architecture, by which the system can easily be adapted to different diseases and applications. Methods We designed a framework upon the Web MVC-based architecture in which the reusable and extractable models can be conveniently adapted to other hospital information systems and which allows for efficient database integration. Then, we determined the clinical variables of the prostate cancer treatment based on participating clinicians' opinions and developed a computational model to determine the pretreatment parameters. Furthermore, the components of the RTCDSS integrated PCRs and decision factors for real-time analysis to provide evidence-based diagrams upon the clinician-oriented interface for visualization of treatment guidance and health risk assessment. Results The resulting system can improve quality of clinical treatment by allowing clinicians to concurrently analyze and evaluate the clinical markers of prostate cancer patients with instantaneous clinical data and evidence-based diagrams which can automatically identify pretreatment parameters. Moreover, the proposed RTCDSS can aid interactions between patients and clinicians. Conclusions Our proposed framework supports online clinical informatics, evaluates treatment risks, offers interactive guidance, and provides real-time reference for decision making in the treatment of prostate cancer. The developed clinician-oriented interface can assist clinicians in conveniently presenting evidence-based information to patients and can be readily adapted to an existing hospital

  16. A simple on-column preparation of [11C]choline. Automation and adaptation to routine production for clinical positron emission tomography (PET)

    International Nuclear Information System (INIS)

    [11C]Choline is currently a potential PET radiopharmaceutical for tumor imaging. For its routine PET application we have developed an automated synthesis system based on the Sep-Pak [11C]methylation method. A simple and highly sensitive method for the detection of residual 2-dimethylaminoethanol (DMAE) in [11C]choline injections was also developed by the combination of headspace solid-phase microextraction (HS-SPME) and gas chromatography-mass spectrometry (GC-MS). Using this system, [11C]choline ready for injection can be obtained in a decay corrected radiochemical yield of 88% with a radiochemical purity of >99% after optimizing reaction parameters. The total synthesis time was 16 min after the end of irradiation. The simplicity, the high efficiency, and the use of disposable components are advantageous for routine clinical use. (author)

  17. Elaboration of gene expression-based clinical decision aids for kidney transplantation: where do we stand?

    Science.gov (United States)

    Brouard, Sophie; Giral, Magali; Soulillou, Jean-Paul; Ashton-Chess, Joanna

    2011-04-15

    Successful kidney transplant management throughout the graft lifespan depends on adequate diagnosis (i.e., recognition of a particular type of graft rejection or injury) and prognosis (i.e., predicting future events or outcome). The currently used methods (mainly graft histology, immunosuppressive drug level monitoring, measurement of renal function, and DSA) have proven highly useful on a population level by indicating good or bad outcome, but are difficult to translate into meaningful tests for individual patients. There is thus a need for diagnostic and predictive tests that add value by being more informative to each patient, more powerful, addressing more specific questions or providing less invasive interventions. Gene expression profiling using microarrays or quantitative PCR has become a benchmark in research into novel and informative monitoring assays for transplantation. A wealth of gene expression studies are reported in the literature spanning two decades. There is now a need for clinical validation so that such tests can become standardized and approved for widespread integration into the standard of care to improve outcome for kidney transplant recipients. PMID:21283062

  18. Improved clinical utility in clavicle fracture decision-making with true orthogonal radiographs

    Directory of Open Access Journals (Sweden)

    Joshua D Harris

    2012-01-01

    Full Text Available Operative treatment of displaced clavicle fractures has demonstrated lower rates of nonunion and symptomatic malunion, improved functional outcomes, and earlier return to activities versus nonoperative treatment. Surgical treatment may offer a reduction in the relative risk of nonunion and symptomatic malunion and an earlier return to work or sport. To present an easy and safe method of acquiring orthogonal views of the clavicle without any manipulation of the patient′s upper extremity. Academic medical center and private clinic in the Midwestern United States; retrospective patient cohort. We reviewed records of patients with acute clavicle fractures between January 2010 and August 2011. Thirty-four patients were treated with sling immobilization and 52 patients were treated surgically with superior plate and screw internal fixation. Prior to the introduction of orthogonal views, 19 patients were treated nonoperatively and 22 treated with internal fixation. Addition of orthogonal views increased the number of patients treated surgically: In the same period, 15 patients were treated nonoperatively and 30 with internal fixation. Following surgery, patients were evaluated in the outpatient office at 2 and 6 weeks and 3 and 6 months. Nonoperatively treated patients were evaluated at 1, 2, and 4 weeks and 3 and 6 months postinjury. Standard use of orthogonal views has led to greater utilization of surgical treatment of clavicle fractures at our institution and improved both the understanding and treatment of these injuries.

  19. CLINICAL DECISION MAKING IN NURSING CARE: EVIDENCE BASED PRACTICE AND SENIORITY

    Directory of Open Access Journals (Sweden)

    Sivasangari Subramaniam

    2015-03-01

    Full Text Available In the nursing profession, EBP makes a positive contribution to healthcare outcomes, care delivery, clinical teaching and research. The research objective was to determine the nurses' knowledge, attitude, practice towards EBP and barriers to use EBP in four (4 Government Hospitals in Malaysia, Hospital Universiti Sains Malaysia (HUSM, Hospital Pulau Pinang (HPP, Hospital Sultan Abdul Halim (HSAH and Hospital Seberang Jaya (HSJ. A cross-sectional study was conducted from January until December 2012 among (n=600 nurses working in all disciplines, on shift or day time duties in four selected hospitals. The questionnaire was adapted from a Singapore study (Majid, 2011. Results showed that among the nurses working in 4 different Malaysian hospitals, close to fifty percent (53 % knew what the evidence based practice meant. The items assessing the attitude showed a large number nurses responding that they did neither agree nor disagree with statements provided. The majority of the remaining nurses tended to show a rather positive attitude except when asked about how the workload interfered with their EBP practice. The practice level of EBP scored a mean of more than 3 out of maximal five for most items. Most nurses recognized there were many barriers to EBP in their working place. In conclusion, this study may have helped to increase our understanding of knowledge, attitudes, practice and barriers towards to use of EBP to the utilization of research by nurses through an exploration of perceived barriers and facilitators on the part of nurses.

  20. A Clinical Decision Support Framework for Incremental Polyps Classification in Virtual Colonoscopy

    Directory of Open Access Journals (Sweden)

    Hiroyuki Yoshida

    2010-01-01

    Full Text Available We present in this paper a novel dynamic learning method for classifying polyp candidate detections in Computed Tomographic Colonography (CTC using an adaptation of the Least Square Support Vector Machine (LS-SVM. The proposed technique, called Weighted Proximal Support Vector Machines (WP-SVM, extends the offline capabilities of the SVM scheme to address practical CTC applications. Incremental data are incorporated in the WP-SVM as a weighted vector space, and the only storage requirements are the hyperplane parameters. WP-SVM performance evaluation based on 169 clinical CTC cases using a 3D computer-aided diagnosis (CAD scheme for feature reduction comparable favorably with previously published CTC CAD studies that have however involved only binary and offline classification schemes. The experimental results obtained from iteratively applying WP-SVM to improve detection sensitivity demonstrate its viability for incremental learning, thereby motivating further follow on research to address a wider range of true positive subclasses such as pedunculated, sessile, and flat polyps, and over a wider range of false positive subclasses such as folds, stool, and tagged materials.

  1. Clinical decision-making: midwifery students' recognition of, and response to, post partum haemorrhage in the simulation environment

    Directory of Open Access Journals (Sweden)

    Scholes Julie

    2012-03-01

    Full Text Available Abstract Background This paper reports the findings of a study of how midwifery students responded to a simulated post partum haemorrhage (PPH. Internationally, 25% of maternal deaths are attributed to severe haemorrhage. Although this figure is far higher in developing countries, the risk to maternal wellbeing and child health problem means that all midwives need to remain vigilant and respond appropriately to early signs of maternal deterioration. Methods Simulation using a patient actress enabled the research team to investigate the way in which 35 midwifery students made decisions in a dynamic high fidelity PPH scenario. The actress wore a birthing suit that simulated blood loss and a flaccid uterus on palpation. The scenario provided low levels of uncertainty and high levels of relevant information. The student's response to the scenario was videoed. Immediately after, they were invited to review the video, reflect on their performance and give a commentary as to what affected their decisions. The data were analysed using Dimensional Analysis. Results The students' clinical management of the situation varied considerably. Students struggled to prioritise their actions where more than one response was required to a clinical cue and did not necessarily use mnemonics as heuristic devices to guide their actions. Driven by a response to single cues they also showed a reluctance to formulate a diagnosis based on inductive and deductive reasoning cycles. This meant they did not necessarily introduce new hypothetical ideas against which they might refute or confirm a diagnosis and thereby eliminate fixation error. Conclusions The students response demonstrated that a number of clinical skills require updating on a regular basis including: fundal massage technique, the use of emergency standing order drugs, communication and delegation of tasks to others in an emergency and working independently until help arrives. Heuristic devices helped the

  2. Clinical laboratory evaluation of the Abbott MS-2 automated antimicrobial susceptibility testing system: report of a collaborative study.

    OpenAIRE

    Thornsberry, C; Anhalt, J P; Washington, J A; McCarthy, L R; Schoenknecht, F D; Sherris, J. C.; Spencer, H J

    1980-01-01

    The MS-2 system (Abbott Diagnostics, Division of Abbott Laboratories, Dallas, Tex.) was evaluated for its efficacy in determining the susceptibilities of both clinical and selected challenge (nonfastidious, facultative, and aerobic) isolates. The MS-2 results were compared with standard Kirby-Bauer disk diffusion and microdilution results by using fresh clinical isolates. For gram-positive isolates other than enterococci, overall agreement between MS-2 and reference results was 93 to 98%. Wit...

  3. Clinical decision support of therapeutic drug monitoring of phenytoin: measured versus adjusted phenytoin plasma concentrations

    Directory of Open Access Journals (Sweden)

    Krasowski Matthew D

    2012-02-01

    Full Text Available Abstract Background Therapeutic drug monitoring of phenytoin by measurement of plasma concentrations is often employed to optimize clinical efficacy while avoiding adverse effects. This is most commonly accomplished by measurement of total phenytoin plasma concentrations. However, total phenytoin levels can be misleading in patients with factors such as low plasma albumin that alter the free (unbound concentrations of phenytoin. Direct measurement of free phenytoin concentrations in plasma is more costly and time-consuming than determination of total phenytoin concentrations. An alternative to direct measurement of free phenytoin concentrations is use of the Sheiner-Tozer equation to calculate an adjusted phenytoin that corrects for the plasma albumin concentration. Innovative medical informatics tools to identify patients who would benefit from adjusted phenytoin calculations or from laboratory measurement of free phenytoin are needed to improve safety and efficacy of phenytoin pharmacotherapy. The electronic medical record for an academic medical center was searched for the time period from August 1, 1996 to November 30, 2010 for patients who had total phenytoin and free phenytoin determined on the same blood draw, and also a plasma albumin measurement within 7 days of the phenytoin measurements. The measured free phenytoin plasma concentration was used as the gold standard. Results In this study, the standard Sheiner-Tozer formula for calculating an estimated (adjusted phenytoin level more frequently underestimates than overestimates the measured free phenytoin relative to the respective therapeutic ranges. Adjusted phenytoin concentrations provided superior classification of patients than total phenytoin measurements, particularly at low albumin concentrations. Albumin plasma concentrations up to 7 days prior to total phenytoin measurements can be used for adjusted phenytoin concentrations. Conclusions The results suggest that a measured

  4. An automated method for nonparametric kinetic analysis of clinical DCE-MRI data: application to glioblastoma treated with bevacizumab.

    Science.gov (United States)

    Ferl, Gregory Z; Xu, Lu; Friesenhahn, Michel; Bernstein, Lisa J; Barboriak, Daniel P; Port, Ruediger E

    2010-05-01

    Here, we describe an automated nonparametric method for evaluating gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA) kinetics, based on dynamic contrast-enhanced-MRI scans of glioblastoma patients taken before and after treatment with bevacizumab; no specific model or equation structure is assumed or used. Tumor and venous blood concentration-time profiles are smoothed, using a robust algorithm that removes artifacts due to patient motion, and then deconvolved, yielding an impulse response function. In addition to smoothing, robustness of the deconvolution operation is assured by excluding data that occur prior to the plasma peak; an exhaustive analysis was performed to demonstrate that exclusion of the prepeak plasma data does not significantly affect results. All analysis steps are executed by a single R script that requires blood and tumor curves as the sole input. Statistical moment analysis of the Impulse response function yields the area under the curve (AUC) and mean residence time (MRT). Comparison of deconvolution results to fitted Tofts model parameters suggests that AUCMRT and AUC of the Impulse response function closely approximate fractional clearance from plasma to tissue (K(trans)) and fractional interstitial volume (v(e)). Intervisit variability is shown to be comparable when using the deconvolution method (11% [AUCMRT] and 13%[AUC]) compared to the Tofts model (14%[K(trans)] and 24%[v(e)]). AUC and AUCMRT both exhibit a statistically significant decrease (P < 0.005) 1 day after administration of bevacizumab. PMID:20432307

  5. Training family physicians and residents in family medicine in shared decision making to improve clinical decisions regarding the use of antibiotics for acute respiratory infections: protocol for a clustered randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Frémont Pierre

    2011-01-01

    and physicians, intention to engage in SDM in future clinical encounters will be assessed. Intention-to-treat analyses will be applied and account for the nested design of the trial will be taken into consideration. Discussion DECISION+2 has the potential to reduce antibiotics use for ARIs by priming physicians and patients to share decisional process and empowering patients to make informed, value-based decisions. Trial Registration ClinicalTrials.gov: NCT01116076

  6. An Electronic Clinical Decision Support Tool to Assist Primary Care Providers in Cardiovascular Disease Risk Management: Development and Mixed Methods Evaluation

    OpenAIRE

    Peiris, David P; Joshi, Rohina; Webster, Ruth J; Groenestein, Patrick; Usherwood, Tim P; Heeley, Emma; Turnbull, Fiona M; Lipman, Alexandra; Patel, Anushka A.

    2009-01-01

    Background Challenges remain in translating the well-established evidence for management of cardiovascular disease (CVD) risk into clinical practice. Although electronic clinical decision support (CDS) systems are known to improve practitioner performance, their development in Australian primary health care settings is limited. Objectives Study aims were to (1) develop a valid CDS tool that assists Australian general practitioners (GPs) in global CVD risk management, and (2) preliminarily eva...

  7. Accuracy of the “traffic light” clinical decision rule for serious bacterial infections in young children with fever: a retrospective cohort study

    OpenAIRE

    Sukanya; Williams, Gabrielle J; Hayen, Andrew; Macaskill, Petra; McCaskill, Mary; Isaacs, David; Craig, Jonathan C.

    2013-01-01

    Objectives To determine the accuracy of a clinical decision rule (the traffic light system developed by the National Institute for Health and Clinical Excellence (NICE)) for detecting three common serious bacterial infections (urinary tract infection, pneumonia, and bacteraemia) in young febrile children. Design Retrospective analysis of data from a two year prospective cohort study Setting A paediatric emergency department. Participants 15 781 cases of children under 5 years of age presentin...

  8. Assessing the effect of an interactive decision-aid smartphone smoking cessation application (app) on quit rates: a double-blind automated randomised control trial protocol

    OpenAIRE

    BinDhim, Nasser F; McGeechan, Kevin; Trevena, Lyndal

    2014-01-01

    Introduction In a previous study exploring the feasibility of a smoking cessation application (app), we found that about 77% of the respondents from three countries were ready to quit in the next 30 days without significant differences between countries in terms of age, operating system and number of quitting attempts. However, the efficacy of smartphone apps for smoking cessation has not yet been established. This study tests the efficacy of a smartphone smoking cessation decision-aid app co...

  9. Automated Import of Clinical Data from HL7 Messages into OpenClinica and tranSMART Using Mirth Connect.

    Science.gov (United States)

    Camacho Rodriguez, Juan Carlos; Stäubert, Sebastian; Löbe, Matthias

    2016-01-01

    Electronic data capture (EDC) tools are designed to simplify data acquisition, improving data quality and managing clinical data electronically. Some data are collected from the laboratory information management system (LIMS), which is an important data source for a study. OpenClinica is an open source clinical data management system (CDMS) for web-based electronic data capture (EDC), which is used widely in academic clinical research. TranSMART is also an open source web-based platform used for the management and analysis of different data types common in clinical and translational research. Many LIMS use the Health Level 7 standard - Version 2.x (HL7) as a message exchange protocol. In this paper, we implement Mirth Connect as a Communication Server (CS) to convert these HL7 messages either to Operational Data Model (ODM) data for the automatic import in OpenClinica or tabular-delimited text format files, whose data is uploaded in tranSMART using the tMDataLoader tool. PMID:27577395

  10. Using Clinical Decision Support and Dashboard Technology to Improve Heart Team Efficiency and Accuracy in a Transcatheter Aortic Valve Implantation (TAVI) Program.

    Science.gov (United States)

    Clarke, Sarah; Wilson, Marisa L; Terhaar, Mary

    2016-01-01

    Heart Team meetings are becoming the model of care for patients undergoing transcatheter aortic valve implantations (TAVI) worldwide. While Heart Teams have potential to improve the quality of patient care, the volume of patient data processed during the meeting is large, variable, and comes from different sources. Thus, consolidation is difficult. Also, meetings impose substantial time constraints on the members and financial pressure on the institution. We describe a clinical decision support system (CDSS) designed to assist the experts in treatment selection decisions in the Heart Team. Development of the algorithms and visualization strategy required a multifaceted approach and end-user involvement. An innovative feature is its ability to utilize algorithms to consolidate data and provide clinically useful information to inform the treatment decision. The data are integrated using algorithms and rule-based alert systems to improve efficiency, accuracy, and usability. Future research should focus on determining if this CDSS improves patient selection and patient outcomes. PMID:27332170

  11. Clinical feasibility of a myocardial signal intensity threshold-based semi-automated cardiac magnetic resonance segmentation method

    Energy Technology Data Exchange (ETDEWEB)

    Varga-Szemes, Akos; Schoepf, U.J.; Suranyi, Pal; De Cecco, Carlo N.; Fox, Mary A. [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); Muscogiuri, Giuseppe [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); University of Rome ' ' Sapienza' ' , Department of Medical-Surgical Sciences and Translational Medicine, Rome (Italy); Wichmann, Julian L. [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); Cannao, Paola M. [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); University of Milan, Scuola di Specializzazione in Radiodiagnostica, Milan (Italy); Renker, Matthias [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); Kerckhoff Heart and Thorax Center, Bad Nauheim (Germany); Mangold, Stefanie [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); Eberhard-Karls University Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); Ruzsics, Balazs [Royal Liverpool and Broadgreen University Hospitals, Department of Cardiology, Liverpool (United Kingdom)

    2016-05-15

    To assess the accuracy and efficiency of a threshold-based, semi-automated cardiac MRI segmentation algorithm in comparison with conventional contour-based segmentation and aortic flow measurements. Short-axis cine images of 148 patients (55 ± 18 years, 81 men) were used to evaluate left ventricular (LV) volumes and mass (LVM) using conventional and threshold-based segmentations. Phase-contrast images were used to independently measure stroke volume (SV). LV parameters were evaluated by two independent readers. Evaluation times using the conventional and threshold-based methods were 8.4 ± 1.9 and 4.2 ± 1.3 min, respectively (P < 0.0001). LV parameters measured by the conventional and threshold-based methods, respectively, were end-diastolic volume (EDV) 146 ± 59 and 134 ± 53 ml; end-systolic volume (ESV) 64 ± 47 and 59 ± 46 ml; SV 82 ± 29 and 74 ± 28 ml (flow-based 74 ± 30 ml); ejection fraction (EF) 59 ± 16 and 58 ± 17 %; and LVM 141 ± 55 and 159 ± 58 g. Significant differences between the conventional and threshold-based methods were observed in EDV, ESV, and LVM measurements; SV from threshold-based and flow-based measurements were in agreement (P > 0.05) but were significantly different from conventional analysis (P < 0.05). Excellent inter-observer agreement was observed. Threshold-based LV segmentation provides improved accuracy and faster assessment compared to conventional contour-based methods. (orig.)

  12. Clinical feasibility of a myocardial signal intensity threshold-based semi-automated cardiac magnetic resonance segmentation method

    International Nuclear Information System (INIS)

    To assess the accuracy and efficiency of a threshold-based, semi-automated cardiac MRI segmentation algorithm in comparison with conventional contour-based segmentation and aortic flow measurements. Short-axis cine images of 148 patients (55 ± 18 years, 81 men) were used to evaluate left ventricular (LV) volumes and mass (LVM) using conventional and threshold-based segmentations. Phase-contrast images were used to independently measure stroke volume (SV). LV parameters were evaluated by two independent readers. Evaluation times using the conventional and threshold-based methods were 8.4 ± 1.9 and 4.2 ± 1.3 min, respectively (P < 0.0001). LV parameters measured by the conventional and threshold-based methods, respectively, were end-diastolic volume (EDV) 146 ± 59 and 134 ± 53 ml; end-systolic volume (ESV) 64 ± 47 and 59 ± 46 ml; SV 82 ± 29 and 74 ± 28 ml (flow-based 74 ± 30 ml); ejection fraction (EF) 59 ± 16 and 58 ± 17 %; and LVM 141 ± 55 and 159 ± 58 g. Significant differences between the conventional and threshold-based methods were observed in EDV, ESV, and LVM measurements; SV from threshold-based and flow-based measurements were in agreement (P > 0.05) but were significantly different from conventional analysis (P < 0.05). Excellent inter-observer agreement was observed. Threshold-based LV segmentation provides improved accuracy and faster assessment compared to conventional contour-based methods. (orig.)

  13. Clinical Decision-Making in Community Children's Mental Health: Using Innovative Methods to Compare Clinicians with and without Training in Evidence-Based Treatment

    Science.gov (United States)

    Baker-Ericzén, Mary J.; Jenkins, Melissa M.; Park, Soojin; Garland, Ann F.

    2015-01-01

    Background: Mental health professionals' decision-making practice is an area of increasing interest and importance, especially in the pediatric research and clinical communities. Objective: The present study explored the role of prior training in evidence-based treatments (EBTs) on clinicians' assessment and treatment formulations using…

  14. The Development and Validation of a Tool to Measure Self-Confidence and Anxiety in Nursing Students While Making Clinical Decisions

    Science.gov (United States)

    White, Krista Alaine

    2011-01-01

    Clinical decision making (CDM) is a cornerstone skill for nurses. Self-confidence and anxiety are two affective influences that impact the learning and adeptness of CDM. Currently, no instruments exist that measure perceived self-confidence and anxiety level of undergraduate nursing students related to CDM. The purpose of this research was to…

  15. An Organizational Informatics Analysis of Colorectal, Breast, and Cervical Cancer Screening Clinical Decision Support and Information Systems within Community Health Centers

    Science.gov (United States)

    Carney, Timothy Jay

    2012-01-01

    A study design has been developed that employs a dual modeling approach to identify factors associated with facility-level cancer screening improvement and how this is mediated by the use of clinical decision support. This dual modeling approach combines principles of (1) Health Informatics, (2) Cancer Prevention and Control, (3) Health Services…

  16. A clinical decision rule for the use of plain radiography in children after acute wrist injury: development and external validation of the Amsterdam Pediatric Wrist Rules

    NARCIS (Netherlands)

    A. Slaar (Annelie); M.M.J. Walenkamp (Monique); A. Bentohami (Abdelali); M. Maas (Mario); R.R. van Rijn (Rick); E.W. Steyerberg (Ewout); L.C. Jager (L. Cara); N.L. Sosef (Nico L.); R. van Velde (Romuald); J.M. Ultee (Jan); J.C. Goslings (Carel); N.W.L. Schep (Niels)

    2016-01-01

    textabstractBackground: In most hospitals, children with acute wrist trauma are routinely referred for radiography. Objective: To develop and validate a clinical decision rule to decide whether radiography in children with wrist trauma is required. Materials and methods: We prospectively developed a

  17. Automating The Work at The Skin and Allergy Private Clinic : A Case Study on Using an Imaging Database to Manage Patients Records

    Science.gov (United States)

    Alghalayini, Mohammad Abdulrahman

    Today, many institutions and organizations are facing serious problem due to the tremendously increasing size of documents, and this problem is further triggering the storage and retrieval problems due to the continuously growing space and efficiency requirements. This problem is becoming more complex with time and the increase in the size and number of documents in an organization; therefore, there is a world wide growing demand to address this problem. This demand and challenge can be met by converting the tremendous amount of paper documents to images using a process to enable specialized document imaging people to select the most suitable image type and scanning resolution to use when there is a need for storing documents images. This documents management process, if applied, attempts to solve the problem of the image storage type and size to some extent. In this paper, we present a case study resembling an applied process to manage the registration of new patients in a private clinic and to optimize following up the registered patients after having their information records stored in an imaging database system; therefore, through this automation approach, we optimize the work process and maximize the efficiency of the Skin and Allergy Clinic tasks.

  18. Automated systems for the de-identification of longitudinal clinical narratives: Overview of 2014 i2b2/UTHealth shared task Track 1.

    Science.gov (United States)

    Stubbs, Amber; Kotfila, Christopher; Uzuner, Özlem

    2015-12-01

    The 2014 i2b2/UTHealth Natural Language Processing (NLP) shared task featured four tracks. The first of these was the de-identification track focused on identifying protected health information (PHI) in longitudinal clinical narratives. The longitudinal nature of clinical narratives calls particular attention to details of information that, while benign on their own in separate records, can lead to identification of patients in combination in longitudinal records. Accordingly, the 2014 de-identification track addressed a broader set of entities and PHI than covered by the Health Insurance Portability and Accountability Act - the focus of the de-identification shared task that was organized in 2006. Ten teams tackled the 2014 de-identification task and submitted 22 system outputs for evaluation. Each team was evaluated on their best performing system output. Three of the 10 systems achieved F1 scores over .90, and seven of the top 10 scored over .75. The most successful systems combined conditional random fields and hand-written rules. Our findings indicate that automated systems can be very effective for this task, but that de-identification is not yet a solved problem. PMID:26225918

  19. Automation of the radiosynthesis and purification procedures for [18F]Fluspidine preparation, a new radiotracer for clinical investigations in PET imaging of σ1 receptors in brain

    International Nuclear Information System (INIS)

    The radiosynthesis of [18F]Fluspidine, a potent σ1 receptor imaging probe for pre-clinical/clinical studies, was implemented on a TRACERlabTM FX F-N synthesizer. [18F]2 was synthesized in 15 min at 85 °C starting from its tosylate precursor. Purification via semi-preparative RP-HPLC was investigated using different columns and eluent compositions and was most successful on a polar RP phase with acetonitrile/water buffered with NH4OAc. After solid phase extraction, [18F]Fluspidine was formulated and produced within 59±4 min with an overall radiochemical yield of 37±8%, a radiochemical purity of 99.3±0.5% and high specific activity (176.6±52.0 GBq/µmol). - Highlights: • [18F]Fluspidine is a promising radiotracer for PET imaging of sigma1 receptors. • A fully automated CGMP-oriented radiosynthesis of [18F]Fluspidine is described. • The purification was investigated using different semi-preparative HPLC systems. • [18F]Fluspidine was produced within 59±4 min with a radiochemical yield of 37±8%

  20. Automation bias: a systematic review of frequency, effect mediators, and mitigators

    OpenAIRE

    Goddard, Kate; Roudsari, Abdul; Wyatt, Jeremy C.

    2011-01-01

    Automation bias (AB)—the tendency to over-rely on automation—has been studied in various academic fields. Clinical decision support systems (CDSS) aim to benefit the clinical decision-making process. Although most research shows overall improved performance with use, there is often a failure to recognize the new errors that CDSS can introduce. With a focus on healthcare, a systematic review of the literature from a variety of research fields has been carried out, assessing the frequency and s...

  1. RECOVER - An Automated Burned Area Emergency Response Decision Support System for Post-fire Rehabilitation Management of Savanna Ecosystems in the Western US

    Science.gov (United States)

    Weber, K.; Schnase, J. L.; Carroll, M.; Brown, M. E.; Gill, R.; Haskett, G.; Gardner, T.

    2013-12-01

    In partnership with the Department of Interior's Bureau of Land Management (BLM) and the Idaho Department of Lands (IDL), we are building and evaluating the RECOVER decision support system. RECOVER - which stands for Rehabilitation Capability Convergence for Ecosystem Recovery - is an automatically deployable, context-aware decision support system for savanna wildfires that brings together in a single application the information necessary for post-fire rehabilitation decision-making and long-term ecosystem monitoring. RECOVER uses state-of-the-art cloud-based data management technologies to improve performance, reduce cost, and provide site-specific flexibility for each fire. The RECOVER Server uses Integrated Rule-Oriented Data System (iRODS) data grid technology deployed in the Amazon Elastic Compute Cloud (EC2). The RECOVER Client is an Adobe Flex web map application that is able to provide a suite of convenient GIS analytical capabilities. In a typical use scenario, the RECOVER Server is provided a wildfire name and geospatial extent. The Server then automatically gathers Earth observational data and other relevant products from various geographically distributed data sources. The Server creates a database in the cloud where all relevant information about the wildfire is stored. This information is made available to the RECOVER Client and ultimately to fire managers through their choice of web browser. The Server refreshes the data throughout the burn and subsequent recovery period (3-5 years) with each refresh requiring two minutes to complete. Since remediation plans must be completed within 14 days of a fire's containment, RECOVER has the potential to significantly improve the decision-making process. RECOVER adds an important new dimension to post-fire decision-making by focusing on ecosystem rehabilitation in semiarid savannas. A novel aspect of RECOVER's approach involves the use of soil moisture estimates, which are an important but difficult

  2. Library Automation

    OpenAIRE

    Dhakne, B. N.; Giri, V. V; Waghmode, S. S.

    2010-01-01

    New technologies library provides several new materials, media and mode of storing and communicating the information. Library Automation reduces the drudgery of repeated manual efforts in library routine. By use of library automation collection, Storage, Administration, Processing, Preservation and communication etc.

  3. The Role of Proteomics in Biomarker Development for Improved Patient Diagnosis and Clinical Decision Making in Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Claire L. Tonry

    2016-07-01

    Full Text Available Prostate Cancer (PCa is the second most commonly diagnosed cancer in men worldwide. Although increased expression of prostate-specific antigen (PSA is an effective indicator for the recurrence of PCa, its intended use as a screening marker for PCa is of considerable controversy. Recent research efforts in the field of PCa biomarkers have focused on the identification of tissue and fluid-based biomarkers that would be better able to stratify those individuals diagnosed with PCa who (i might best receive no treatment (active surveillance of the disease; (ii would benefit from existing treatments; or (iii those who are likely to succumb to disease recurrence and/or have aggressive disease. The growing demand for better prostate cancer biomarkers has coincided with the development of improved discovery and evaluation technologies for multiplexed measurement of proteins in bio-fluids and tissues. This review aims to (i provide an overview of these technologies as well as describe some of the candidate PCa protein biomarkers that have been discovered using them; (ii address some of the general limitations in the clinical evaluation and validation of protein biomarkers; and (iii make recommendations for strategies that could be adopted to improve the successful development of protein biomarkers to deliver improvements in personalized PCa patient decision making.

  4. GOAL: an inverse toxicity-related algorithm for daily clinical practice decision making in advanced kidney cancer.

    Science.gov (United States)

    Bracarda, Sergio; Sisani, Michele; Marrocolo, Francesca; Hamzaj, Alketa; del Buono, Sabrina; De Simone, Valeria

    2014-03-01

    Metastatic renal cell carcinoma (mRCC), considered almost an orphan disease only six years ago, appears today a very dynamic pathology. The recently switch to the actual overcrowded scenario defined by seven active drugs has driven physicians to an incertitude status, due to difficulties in defining the best possible treatment strategy. This situation is mainly related to the absence of predictive biomarkers for any available or new therapy. Such issue, associated with the nearly absence of published face-to-face studies, draws a complex picture frame. In order to solve this dilemma, decisional algorithms tailored on drug efficacy data and patient profile are recognized as very useful tools. These approaches try to select the best therapy suitable for every patient profile. On the contrary, the present review has the "goal" to suggest a reverse approach: basing on the pivotal studies, post-marketing surveillance reports and our experience, we defined the polarizing toxicity (the most frequent toxicity in the light of clinical experience) for every single therapy, creating a new algorithm able to identify the patient profile, mainly comorbidities, unquestionably unsuitable for each single agent presently available for either the first- or the second-line therapy. The GOAL inverse decision-making algorithm, proposed at the end of this review, allows to select the best therapy for mRCC by reducing the risk of limiting toxicities. PMID:24309065

  5. Cesarean section without clinical indication versus vaginal delivery as a paradigmatic model in the discourse of medical setting decisions.

    Science.gov (United States)

    Demontis, Roberto; Pisu, Salvatore; Pintor, Michela; D'aloja, Ernesto

    2011-12-01

    Natural childbirth has ceased to be considered the gold standard in the delivery room. For this reason cesarean section on demand is increasing. Many obstetricians justify this phenomenon on evidence-based obstetrical practice. However, other pieces of evidence demonstrate that the data are often a product of the social milieu, and as stated by Wendland, "technology magically wards off the unpredictability and danger of birth". In a recent paper, Kalish pointed out several problems with cesarean deliveries in the absence of medical indications regarding issues of good clinical practice, autonomy, and informed consent. From the late 1990s, the medical community began to speak in favor of women's autonomy in childbirth decisions thus supporting the maternal choice and request for a cesarean section. Starting from these new considerations, it is of primary importance to understand whether emphasizing patient's autonomy is the best, or the only, way to helping the medical decisional process. This general approach may be helpful in all the other cases in which patient's autonomy and physician's responsibility appear to be intertwined in an apparent conflicting manner. We fear that the rhetoric of autonomous choice represents a fundamental shift from medicine-based beneficence toward a perilous relationship founded mainly on patient's wishes, representing a dangerous slippery slope where the physician could be reduced to the role of a functionary delegated to execute patient's claims and demands. PMID:21158491

  6. Coupling Clinical Decision Support System with Computerized Prescriber Order Entry and their Dynamic Plugging in the Medical Workflow System

    CERN Document Server

    Bouzguenda, Lotfi

    2012-01-01

    This work deals with coupling Clinical Decision Support System (CDSS) with Computerized Prescriber Order Entry (CPOE) and their dynamic plugging in the medical Workflow Management System (WfMS). First, in this paper we argue some existing CDSS representative of the state of the art in order to emphasize their inability to deal with coupling with CPOE and medical WfMS. The multi-agent technology is at the basis of our proposition since (i) it provides natural abstractions to deal with distribution, heterogeneity and autonomy which are inherent to the previous systems (CDSS, CPOE and medical WfMS), and (ii) it introduces powerful concepts such as organizations, goals and roles useful to describe in details the coordination of the different components involved in these systems. In this paper, we also propose a Multi-Agent System (MAS) to support the coupling CDSS with CPOE. Finally, we show how we integrate the proposed MAS in the medical workflow management system which is also based on collaborating agents

  7. Process automation

    International Nuclear Information System (INIS)

    Process automation technology has been pursued in the chemical processing industries and to a very limited extent in nuclear fuel reprocessing. Its effective use has been restricted in the past by the lack of diverse and reliable process instrumentation and the unavailability of sophisticated software designed for process control. The Integrated Equipment Test (IET) facility was developed by the Consolidated Fuel Reprocessing Program (CFRP) in part to demonstrate new concepts for control of advanced nuclear fuel reprocessing plants. A demonstration of fuel reprocessing equipment automation using advanced instrumentation and a modern, microprocessor-based control system is nearing completion in the facility. This facility provides for the synergistic testing of all chemical process features of a prototypical fuel reprocessing plant that can be attained with unirradiated uranium-bearing feed materials. The unique equipment and mission of the IET facility make it an ideal test bed for automation studies. This effort will provide for the demonstration of the plant automation concept and for the development of techniques for similar applications in a full-scale plant. A set of preliminary recommendations for implementing process automation has been compiled. Some of these concepts are not generally recognized or accepted. The automation work now under way in the IET facility should be useful to others in helping avoid costly mistakes because of the underutilization or misapplication of process automation. 6 figs

  8. The design and implementation of an Interactive Computerised Decision Support Framework (ICDSF) as a strategy to improve nursing students' clinical reasoning skills.

    Science.gov (United States)

    Hoffman, Kerry; Dempsey, Jennifer; Levett-Jones, Tracy; Noble, Danielle; Hickey, Noelene; Jeong, Sarah; Hunter, Sharyn; Norton, Carol

    2011-08-01

    This paper describes the conceptual design and testing of an Interactive Computerised Decision Support Framework (ICDSF) which was constructed to enable student nurses to "think like a nurse." The ICDSF was based on a model of clinical reasoning. Teaching student nurses to reason clinically is important as poor clinical reasoning skills can lead to "failure-to rescue" of deteriorating patients. The framework of the ICDSF was based on nursing concepts to encourage deep learning and transferability of knowledge. The principles of active student participation, situated cognition to solve problems, authenticity, and cognitive rehearsal were used to develop the ICDSF. The ICDSF was designed in such a way that students moved through it in a step-wise fashion and were required to achieve competency at each step before proceeding to the next. The quality of the ICDSF was evaluated using a questionairre survey, students' written comments and student assessment measures on a pilot and the ICDSF. Overall students were highly satisfied with the clinical scenarios of the ICDSF and believed they were an interesting and useful way to engage in authentic clinical learning. They also believed the ICDSF was useful in developing cognitive skills such as clinical reasoning, problem-solving and decision-making. Some reported issues were the need for good technical support and the lack of face to face contact when using e-learning. Some students also believed the ICDSF was less useful than actual clinical placements. PMID:21074299

  9. Análise comparativa da refração automática objetiva e refração clínica Automatic objective refraction and clinical refraction - a comparative analysis

    Directory of Open Access Journals (Sweden)

    Ricardo Uras

    2001-02-01

    Full Text Available Objetivo: Este estudo buscou verificar se a prescrição adequada de lentes corretoras pode ser realizada exclusivamente com os dados fornecidos pela refração automática objetiva. Métodos: Todos os pacientes foram submetidos a anamnese, exame oftalmológico. A refração clínica, por meio de recursos propedêuticos clássicos não - automatizados objetivos e subjetivos para prescrição de lentes corretoras ("gold standard", seguido por exame no refrator automático TOPCON KR 3000. Resultados: Foram estudados 1001 olhos de 504 pacientes, dos quais 45,2%, do sexo masculino. A média de idade foi de 36,6 anos. O índice geral de concordância de diagnóstico entre refração clínica e refração automática objetiva foi de 66,7%. Considerando-se tolerância de -0,50 a +0,50 DE, o índice de concordância quanto ao componente esférico foi de cerca de 90%. Houve concordância em 27,60% dos astigmatismos hipermetrópicos e miópicos simples e de 97,7% nos astigmatismos compostos e no astigmatismo misto. A cicloplegia não alterou de maneira estatisticamente significante o índice de concordância de diagnóstico. O eixo das lentes cilíndricas indicado pela refração automática objetiva apresentou proximidade estatisticamente significante ao eixo da refração clínica. Conclusão: A refração automática objetiva fornece dados úteis para a prescrição de lentes corretoras, desde que se levem em consideração variáveis como uso prévio ou não de óculos, idade e cicloplegia. A prescrição de lentes corretoras não pode ser realizada exclusivamente com os dados fornecidos pela refração automática objetiva.Purpose: This study was designed to determine if lens prescription can be based solely on automated objective refraction. Methods: All patients were interviewed and underwent an ophthalmologic examination including clinical refraction with classical non-automated objective and subjective procedures (gold standard. Afterwards the

  10. A clinical decision rule for the use of plain radiography in children after acute wrist injury: development and external validation of the Amsterdam Pediatric Wrist Rules

    International Nuclear Information System (INIS)

    In most hospitals, children with acute wrist trauma are routinely referred for radiography. To develop and validate a clinical decision rule to decide whether radiography in children with wrist trauma is required. We prospectively developed and validated a clinical decision rule in two study populations. All children who presented in the emergency department of four hospitals with pain following wrist trauma were included and evaluated for 18 clinical variables. The outcome was a wrist fracture diagnosed by plain radiography. Included in the study were 787 children. The prediction model consisted of six variables: age, swelling of the distal radius, visible deformation, distal radius tender to palpation, anatomical snuffbox tender to palpation, and painful or abnormal supination. The model showed an area under the receiver operator characteristics curve of 0.79 (95% CI: 0.76-0.83). The sensitivity and specificity were 95.9% and 37.3%, respectively. The use of this model would have resulted in a 22% absolute reduction of radiographic examinations. In a validation study, 7/170 fractures (4.1%, 95% CI: 1.7-8.3%) would have been missed using the decision model. The decision model may be a valuable tool to decide whether radiography in children after wrist trauma is required. (orig.)

  11. A clinical decision rule for the use of plain radiography in children after acute wrist injury: development and external validation of the Amsterdam Pediatric Wrist Rules

    Energy Technology Data Exchange (ETDEWEB)

    Slaar, Annelie; Maas, Mario; Rijn, Rick R. van [University of Amsterdam, Department of Radiology, Academic Medical Centre, Meibergdreef 9, 1105, AZ, Amsterdam (Netherlands); Walenkamp, Monique M.J.; Bentohami, Abdelali; Goslings, J.C. [University of Amsterdam, Trauma Unit, Department of Surgery, Academic Medical Centre, Amsterdam (Netherlands); Steyerberg, Ewout W. [Erasmus MC - University Medical Centre, Department of Public Health, Rotterdam (Netherlands); Jager, L.C. [University of Amsterdam, Emergency Department, Academic Medical Centre, Amsterdam (Netherlands); Sosef, Nico L. [Spaarne Hospital, Department of Surgery, Hoofddorp (Netherlands); Velde, Romuald van [Tergooi Hospitals, Department of Surgery, Hilversum (Netherlands); Ultee, Jan M. [Sint Lucas Andreas Hospital, Department of Surgery, Amsterdam (Netherlands); Schep, Niels W.L. [University of Amsterdam, Trauma Unit, Department of Surgery, Academic Medical Centre, Amsterdam (Netherlands); Maasstadziekenhuis Rotterdam, Department of Surgery, Rotterdam (Netherlands)

    2016-01-15

    In most hospitals, children with acute wrist trauma are routinely referred for radiography. To develop and validate a clinical decision rule to decide whether radiography in children with wrist trauma is required. We prospectively developed and validated a clinical decision rule in two study populations. All children who presented in the emergency department of four hospitals with pain following wrist trauma were included and evaluated for 18 clinical variables. The outcome was a wrist fracture diagnosed by plain radiography. Included in the study were 787 children. The prediction model consisted of six variables: age, swelling of the distal radius, visible deformation, distal radius tender to palpation, anatomical snuffbox tender to palpation, and painful or abnormal supination. The model showed an area under the receiver operator characteristics curve of 0.79 (95% CI: 0.76-0.83). The sensitivity and specificity were 95.9% and 37.3%, respectively. The use of this model would have resulted in a 22% absolute reduction of radiographic examinations. In a validation study, 7/170 fractures (4.1%, 95% CI: 1.7-8.3%) would have been missed using the decision model. The decision model may be a valuable tool to decide whether radiography in children after wrist trauma is required. (orig.)

  12. Implementing shared decision-making in nutrition clinical practice: A theory-based approach and feasibility study

    OpenAIRE

    Légaré France; Tapp Sylvie; Gagnon Marie-Pierre; Desroches Sophie

    2008-01-01

    Abstract Background There are a growing number of dietary treatment options to choose from for the management of many chronic diseases. Shared decision making represents a promising approach to improve the quality of the decision making process needed for dietary choices that are informed by the best evidence and value-based. However, there are no studies reporting on theory-based approaches that foster the implementation of shared decision making in health professions allied to medicine. The...

  13. An Automated System for Grading EEG Abnormality in Term Neonates with Hypoxic-Ischaemic Encephalopathy

    OpenAIRE

    Stevenson, N. J.; Korotchikova, I.; Temko, A.; Lightbody, G.; Marnane, W. P.; Boylan, G.B.

    2012-01-01

    Automated analysis of the neonatal EEG has the potential to assist clinical decision making for neonates with hypoxic-ischaemic encephalopathy. This paper proposes a method of automatically grading the degree of abnormality in an hour long epoch of neonatal EEG. The automated grading system (AGS) was based on a multi-class linear classifier grading of short-term epochs of EEG which were converted into a long-term grading of EEG using a majority vote operation. The features used in the AGS wer...

  14. External audit of clinical practice and medical decision making in a new Asian oncology center: Results and implications for both developing and developed nations

    International Nuclear Information System (INIS)

    Purpose: The external audit of oncologist clinical practice is increasingly important because of the incorporation of audits into national maintenance of certification (MOC) programs. However, there are few reports of external audits of oncology practice or decision making. Our institution (The Cancer Institute, Singapore) was asked to externally audit an oncology department in a developing Asian nation, providing a unique opportunity to explore the feasibility of such a process. Methods and Materials: We audited 100 randomly selected patients simulated for radiotherapy in 2003, using a previously reported audit instrument assessing clinical documentation/quality assurance and medical decision making. Results: Clinical documentation/quality assurance, decision making, and overall performance criteria were adequate 74.4%, 88.3%, and 80.2% of the time, respectively. Overall 52.0% of cases received suboptimal management. Multivariate analysis revealed palliative intent was associated with improved documentation/clinical quality assurance (p = 0.07), decision making (p 0.007), overall performance (p = 0.003), and optimal treatment rates (p 0.07); non-small-cell lung cancer or central nervous system primary sites were associated with better decision making (p = 0.001), overall performance (p = 0.03), and optimal treatment rates (p = 0.002). Conclusions: Despite the poor results, the external audit had several benefits. It identified learning needs for future targeting, and the auditor provided facilitating feedback to address systematic errors identified. Our experience was also helpful in refining our national revalidation audit instrument. The feasibility of the external audit supports the consideration of including audit in national MOC programs

  15. Arthritis Quality Indicators for the Veterans Administration: Implications for Electronic Data Collection, Storage Format, Quality Assessment, and Clinical Decision Support

    OpenAIRE

    Williams, Carl A.; Mosley-Williams, Angelia D.; Overhage, J. Marc

    2007-01-01

    The Veterans Administration (VA) uses information technology and performance measures to improve quality and efficiency. The VA stores all patient data electronically. Manual quality assessment audits are performed every three months. They are time consuming and expensive. Automated reviews would be more efficient. But the patient records are neither sufficiently coded nor structured to allow for full machine interpretability.

  16. Working toward Transparency in Library Automation

    Science.gov (United States)

    Breeding, Marshall

    2007-01-01

    In this article, the author argues the need for transparency with regard to the automation systems used in libraries. As librarians make decisions regarding automation software and services, they should have convenient access to information about the organizations it will potentially acquire technology from and about the collective experiences of…

  17. Feasibility of a semi-automated contrast-oriented algorithm for tumor segmentation in retrospectively gated PET images: phantom and clinical validation

    Science.gov (United States)

    Carles, Montserrat; Fechter, Tobias; Nemer, Ursula; Nanko, Norbert; Mix, Michael; Nestle, Ursula; Schaefer, Andrea

    2015-12-01

    PET/CT plays an important role in radiotherapy planning for lung tumors. Several segmentation algorithms have been proposed for PET tumor segmentation. However, most of them do not take into account respiratory motion and are not well validated. The aim of this work was to evaluate a semi-automated contrast-oriented algorithm (COA) for PET tumor segmentation adapted to retrospectively gated (4D) images. The evaluation involved a wide set of 4D-PET/CT acquisitions of dynamic experimental phantoms and lung cancer patients. In addition, segmentation accuracy of 4D-COA was compared with four other state-of-the-art algorithms. In phantom evaluation, the physical properties of the objects defined the gold standard. In clinical evaluation, the ground truth was estimated by the STAPLE (Simultaneous Truth and Performance Level Estimation) consensus of three manual PET contours by experts. Algorithm evaluation with phantoms resulted in: (i) no statistically significant diameter differences for different targets and movements (Δ φ =0.3+/- 1.6 mm); (ii) reproducibility for heterogeneous and irregular targets independent of user initial interaction and (iii) good segmentation agreement for irregular targets compared to manual CT delineation in terms of Dice Similarity Coefficient (DSC  =  0.66+/- 0.04 ), Positive Predictive Value (PPV  =  0.81+/- 0.06 ) and Sensitivity (Sen.  =  0.49+/- 0.05 ). In clinical evaluation, the segmented volume was in reasonable agreement with the consensus volume (difference in volume (%Vol)  =  40+/- 30 , DSC  =  0.71+/- 0.07 and PPV  =  0.90+/- 0.13 ). High accuracy in target tracking position (Δ ME) was obtained for experimental and clinical data (Δ ME{{}\\text{exp}}=0+/- 3 mm; Δ ME{{}\\text{clin}}=0.3+/- 1.4 mm). In the comparison with other lung segmentation methods, 4D-COA has shown the highest volume accuracy in both experimental and clinical data. In conclusion, the accuracy in volume

  18. Evaluation of Nursing Documentation Completion of Stroke Patients in the Emergency Department: A Pre-Post Analysis Using Flowsheet Templates and Clinical Decision Support.

    Science.gov (United States)

    Richardson, Karen J; Sengstack, Patricia; Doucette, Jeffrey N; Hammond, William E; Schertz, Matthew; Thompson, Julie; Johnson, Constance

    2016-02-01

    The primary aim of this performance improvement project was to determine whether the electronic health record implementation of stroke-specific nursing documentation flowsheet templates and clinical decision support alerts improved the nursing documentation of eligible stroke patients in seven stroke-certified emergency departments. Two system enhancements were introduced into the electronic record in an effort to improve nursing documentation: disease-specific documentation flowsheets and clinical decision support alerts. Using a pre-post design, project measures included six stroke management goals as defined by the National Institute of Neurological Disorders and Stroke and three clinical decision support measures based on entry of orders used to trigger documentation reminders for nursing: (1) the National Institutes of Health's Stroke Scale, (2) neurological checks, and (3) dysphagia screening. Data were reviewed 6 months prior (n = 2293) and 6 months following the intervention (n = 2588). Fisher exact test was used for statistical analysis. Statistical significance was found for documentation of five of the six stroke management goals, although effect sizes were small. Customizing flowsheets to meet the needs of nursing workflow showed improvement in the completion of documentation. The effects of the decision support alerts on the completeness of nursing documentation were not statistically significant (likely due to lack of order entry). For example, an order for the National Institutes of Health Stroke Scale was entered only 10.7% of the time, which meant no alert would fire for nursing in the postintervention group. Future work should focus on decision support alerts that trigger reminders for clinicians to place relevant orders for this population. PMID:26679006

  19. Comparison of an effect-model-law-based method versus traditional clinical practice guidelines for optimal treatment decision-making: application to statin treatment in the French population.

    Science.gov (United States)

    Kahoul, Riad; Gueyffier, François; Amsallem, Emmanuel; Haugh, Margaret; Marchant, Ivanny; Boissel, François-Henri; Boissel, Jean-Pierre

    2014-11-01

    Healthcare authorities make difficult decisions about how to spend limited budgets for interventions that guarantee the best cost-efficacy ratio. We propose a novel approach for treatment decision-making, OMES-in French: Objectif thérapeutique Modèle Effet Seuil (in English: Therapeutic Objective-Threshold-Effect Model; TOTEM). This approach takes into consideration results from clinical trials, adjusted for the patients' characteristics in treatment decision-making. We compared OMES with the French clinical practice guidelines (CPGs) for the management of dyslipidemia with statin in a computer-generated realistic virtual population, representing the adult French population, in terms of the number of all-cause deaths avoided (number of avoided events: NAEs) under treatment and the individual absolute benefit. The total budget was fixed at the annual amount reimbursed by the French social security for statins. With the CPGs, the NAEs was 292 for an annual cost of 122.54 M€ compared with 443 with OMES. For a fixed NAEs, OMES reduced costs by 50% (60.53 M€ yr(-1)). The results demonstrate that OMES is at least as good as, and even better than, the standard CPGs when applied to the same population. Hence the OMES approach is a practical, useful alternative which will help to overcome the limitations of treatment decision-making based uniquely on CPGs. PMID:25209407

  20. Comparison of an effect-model-law-based method versus traditional clinical practice guidelines for optimal treatment decision-making: application to statin treatment in the French population

    Science.gov (United States)

    Kahoul, Riad; Gueyffier, François; Amsallem, Emmanuel; Haugh, Margaret; Marchant, Ivanny; Boissel, François-Henri; Boissel, Jean-Pierre

    2014-01-01

    Healthcare authorities make difficult decisions about how to spend limited budgets for interventions that guarantee the best cost-efficacy ratio. We propose a novel approach for treatment decision-making, OMES—in French: Objectif thérapeutique Modèle Effet Seuil (in English: Therapeutic Objective–Threshold–Effect Model; TOTEM). This approach takes into consideration results from clinical trials, adjusted for the patients' characteristics in treatment decision-making. We compared OMES with the French clinical practice guidelines (CPGs) for the management of dyslipidemia with statin in a computer-generated realistic virtual population, representing the adult French population, in terms of the number of all-cause deaths avoided (number of avoided events: NAEs) under treatment and the individual absolute benefit. The total budget was fixed at the annual amount reimbursed by the French social security for statins. With the CPGs, the NAEs was 292 for an annual cost of 122.54 M€ compared with 443 with OMES. For a fixed NAEs, OMES reduced costs by 50% (60.53 M€ yr−1). The results demonstrate that OMES is at least as good as, and even better than, the standard CPGs when applied to the same population. Hence the OMES approach is a practical, useful alternative which will help to overcome the limitations of treatment decision-making based uniquely on CPGs. PMID:25209407

  1. Sample Tracking in an Automated Cytogenetic Biodosimetry Laboratory for Radiation Mass Casualties

    OpenAIRE

    Martin, P.R.; Berdychevski, R.E.; Subramanian, U.; Blakely, W F; Prasanna, P.G.S.

    2007-01-01

    Chromosome aberration-based dicentric assay is expected to be used after mass casualty life-threatening radiation exposures to assess radiation dose to individuals. This will require processing of a large number of samples for individual dose assessment and clinical triage to aid treatment decisions. We have established an automated, high-throughput, cytogenetic biodosimetry laboratory to process a large number of samples for conducting the dicentric assay using peripheral blood from exposed ...

  2. Analysis of the process of representing clinical statements for decision-support applications: a comparison of openEHR archetypes and HL7 virtual medical record.

    Science.gov (United States)

    González-Ferrer, A; Peleg, M; Marcos, M; Maldonado, J A

    2016-07-01

    Delivering patient-specific decision-support based on computer-interpretable guidelines (CIGs) requires mapping CIG clinical statements (data items, clinical recommendations) into patients' data. This is most effectively done via intermediate data schemas, which enable querying the data according to the semantics of a shared standard intermediate schema. This study aims to evaluate the use of HL7 virtual medical record (vMR) and openEHR archetypes as intermediate schemas for capturing clinical statements from CIGs that are mappable to electronic health records (EHRs) containing patient data and patient-specific recommendations. Using qualitative research methods, we analyzed the encoding of ten representative clinical statements taken from two CIGs used in real decision-support systems into two health information models (openEHR archetypes and HL7 vMR instances) by four experienced informaticians. Discussion among the modelers about each case study example greatly increased our understanding of the capabilities of these standards, which we share in this educational paper. Differing in content and structure, the openEHR archetypes were found to contain a greater level of representational detail and structure while the vMR representations took fewer steps to complete. The use of openEHR in the encoding of CIG clinical statements could potentially facilitate applications other than decision-support, including intelligent data analysis and integration of additional properties of data items from existing EHRs. On the other hand, due to their smaller size and fewer details, the use of vMR potentially supports quicker mapping of EHR data into clinical statements. PMID:27209183

  3. Neural network decision support system for effective decision making in the decision to bid process

    OpenAIRE

    Parvar, Jamshid; Lowe, David; Emsley, Margaret

    2002-01-01

    Important factors in the decision to bid process are identified. A rational and optimal model of decision making for the decision to bid process, which depicts the relationships between these factors and the decision to bid options, is developed. Regression models and neural networks approach are employed to automate the rational and optimal model. Prototyping system development methodology is used as the neural networks system development. The neural networks approach in addition to the abil...

  4. A critical appraisal of the literature on the effects of computer-based clinical decision support systems on clinician performance and patient outcomes.

    OpenAIRE

    Langton, K. B.; Johnston, M. E.; Haynes, R. B.; Mathieu, A

    1992-01-01

    OBJECTIVE: To review the evaluations of computer-based clinical decision support systems (CDSS's). DATA SOURCES: The literature collected in the MEDLARS, EMBASE, SCISEARCH and INSPEC databases was searched from 1974 to the present. The reference lists of relevant articles were reviewed as were conference proceedings. STUDY SELECTION: Prospective, controlled studies were included. Studies were rated for methodological quality. DATA EXTRACTION: Study quality was assessed and data on study setti...

  5. Use Of Clinical Decision Analysis In Predicting The Efficacy Of Newer Radiological Imaging Modalities: Radioscintigraphy Versus Single Photon Transverse Section Emission Computed Tomography

    Science.gov (United States)

    Prince, John R.

    1982-12-01

    Sensitivity, specificity, and predictive accuracy have been shown to be useful measures of the clinical efficacy of diagnostic tests and can be used to predict the potential improvement in diagnostic certitude resulting from the introduction of a competing technology. This communication demonstrates how the informal use of clinical decision analysis may guide health planners in the allocation of resources, purchasing decisions, and implementation of high technology. For didactic purposes the focus is on a comparison between conventional planar radioscintigraphy (RS) and single photon transverse section emission conputed tomography (SPECT). For example, positive predictive accuracy (PPA) for brain RS in a specialist hospital with a 50% disease prevalance is about 95%. SPECT should increase this predicted accuracy to 96%. In a primary care hospital with only a 15% disease prevalance the PPA is only 77% and SPECT may increase this accuracy to about 79%. Similar calculations based on published data show that marginal improvements are expected with SPECT in the liver. It is concluded that: a) The decision to purchase a high technology imaging modality such as SPECT for clinical purposes should be analyzed on an individual organ system and institutional basis. High technology may be justified in specialist hospitals but not necessarily in primary care hospitals. This is more dependent on disease prevalance than procedure volume; b) It is questionable whether SPECT imaging will be competitive with standard RS procedures. Research should concentrate on the development of different medical applications.

  6. Use of augmented decision tables to convert probabilistic data into clinical algorithms for the diagnosis of appendicitis.

    OpenAIRE

    Shiffman, R. N.; Greenes, R. A.

    1991-01-01

    Decision table techniques have been shown to be useful for ensuring logical completeness, eliminating ambiguity, and optimizing the translation of logic into flowcharts or computer programs. Nevertheless, they have not been widely applied in medicine. We have used decision table techniques to demonstrate the derivation of two sets of rules for determining whether to operate on patients with suspected appendicitis based on patterns of observed signs and symptoms. One rule set is based on a dia...

  7. Support and Assessment for Fall Emergency Referrals (SAFER 1: cluster randomised trial of computerised clinical decision support for paramedics.

    Directory of Open Access Journals (Sweden)

    Helen Anne Snooks

    Full Text Available To evaluate effectiveness, safety and cost-effectiveness of Computerised Clinical Decision Support (CCDS for paramedics attending older people who fall.Cluster trial randomised by paramedic; modelling.13 ambulance stations in two UK emergency ambulance services.42 of 409 eligible paramedics, who attended 779 older patients for a reported fall.Intervention paramedics received CCDS on Tablet computers to guide patient care. Control paramedics provided care as usual. One service had already installed electronic data capture.Effectiveness: patients referred to falls service, patient reported quality of life and satisfaction, processes of care.Further emergency contacts or death within one month.Costs and quality of life. We used findings from published Community Falls Prevention Trial to model cost-effectiveness.17 intervention paramedics used CCDS for 54 (12.4% of 436 participants. They referred 42 (9.6% to falls services, compared with 17 (5.0% of 343 participants seen by 19 control paramedics [Odds ratio (OR 2.04, 95% CI 1.12 to 3.72]. No adverse events were related to the intervention. Non-significant differences between groups included: subsequent emergency contacts (34.6% versus 29.1%; OR 1.27, 95% CI 0.93 to 1.72; quality of life (mean SF12 differences: MCS -0.74, 95% CI -2.83 to +1.28; PCS -0.13, 95% CI -1.65 to +1.39 and non-conveyance (42.0% versus 36.7%; OR 1.13, 95% CI 0.84 to 1.52. However ambulance job cycle time was 8.9 minutes longer for intervention patients (95% CI 2.3 to 15.3. Average net cost of implementing CCDS was £208 per patient with existing electronic data capture, and £308 without. Modelling estimated cost per quality-adjusted life-year at £15,000 with existing electronic data capture; and £22,200 without.Intervention paramedics referred twice as many participants to falls services with no difference in safety. CCDS is potentially cost-effective, especially with existing electronic data capture.ISRCTN Register ISRCTN

  8. Clinical Informatics Consult Service Positively Affects Some Clinical Decisions in the ICU. A Review of: Mulvaney, Shelagh A., Leonard Bickman, Nunzia B. Giuse, Warren E. Lambert, Nila A. Sathe, and Rebecca N. Jerome." A Randomized Effectiveness Trial of a Clinical Informatics Consult Service: Impact on Evidence-based Decision-making and Knowledge Implementation." Journal of the American Medical Informatics Association 15.2 (2008): 203-11.

    OpenAIRE

    Jennifer Kelson

    2009-01-01

    Objective – To determine whether the provision of synthesized research evidence provided by the Clinical Informatics Consult Service (CICS) affects the clinical decision-making of clinicians working in intensive care units (ICUs).Design – Non-blinded randomized control effectiveness trial.Setting – ICUs in United States-based 658 bed university hospital providing tertiary care for adults and children.Subjects – Clinical staff working within one of four ICUs who submitted a request for clinica...

  9. External audit on the clinical practice and medical decision-making at the departments of radiotherapy in Budapest and Vienna

    International Nuclear Information System (INIS)

    Purpose: To present an example of how to study and analyze the clinical practice and the quality of medical decision-making under daily routine working conditions in a radiotherapy department, with the aims of detecting deficiencies and improving the quality of patient care.Methods: Two departments, each with a divisional organization structure and an established internal audit system, the University Clinic of Radiotherapy and Radiobiology in Vienna (Austria), and the Department of Radiotherapy at the National Institute of Oncology in Budapest (Hungary), conducted common external audits. The descriptive parameters of the external audit provided information on the auditing (auditor and serial number of the audit), the cohorts (diagnosis, referring institution, serial number and intention of radiotherapy) and the staff responsible for the treatment (division and physician). During the ongoing external audits, the qualifying parameters were (1) the sound foundation of the indication of radiotherapy, (2) conformity to the institution protocol (3), the adequacy of the choice of radiation equipment, (4) the appropriateness of the treatment plan, and the correspondence of the latter with (5) the simulation and (6) verification films. Various degrees of deviation from the treatment principles were defined and scored on the basis of the concept of Horiot et al. (Horiot JC, Schueren van der E, Johansson KA, Bernier J, Bartelink H. The program of quality assurance of the EORTC radiotherapy group. A historical overview. Radiother. Oncol. 1993;29:81-84), with some modifications. The action was regarded as adequate (score 1) in the event of no deviation or only a small deviation with presumably no alteration of the desired end-result of the treatment. A deviation adversely influencing the result of the therapy was considered a major deviation (score 3). Cases involving a minor deviation (score 2) were those only slightly affecting the therapeutic end-results, with effects

  10. Using data mining techniques to explore physicians' therapeutic decisions when clinical guidelines do not provide recommendations: methods and example for type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Toussi Massoud

    2009-06-01

    Full Text Available Abstract Background Clinical guidelines carry medical evidence to the point of practice. As evidence is not always available, many guidelines do not provide recommendations for all clinical situations encountered in practice. We propose an approach for identifying knowledge gaps in guidelines and for exploring physicians' therapeutic decisions with data mining techniques to fill these knowledge gaps. We demonstrate our method by an example in the domain of type 2 diabetes. Methods We analyzed the French national guidelines for the management of type 2 diabetes to identify clinical conditions that are not covered or those for which the guidelines do not provide recommendations. We extracted patient records corresponding to each clinical condition from a database of type 2 diabetic patients treated at Avicenne University Hospital of Bobigny, France. We explored physicians' prescriptions for each of these profiles using C5.0 decision-tree learning algorithm. We developed decision-trees for different levels of detail of the therapeutic decision, namely the type of treatment, the pharmaco-therapeutic class, the international non proprietary name, and the dose of each medication. We compared the rules generated with those added to the guidelines in a newer version, to examine their similarity. Results We extracted 27 rules from the analysis of a database of 463 patient records. Eleven rules were about the choice of the type of treatment and thirteen rules about the choice of the pharmaco-therapeutic class of each drug. For the choice of the international non proprietary name and the dose, we could extract only a few rules because the number of patient records was too low for these factors. The extracted rules showed similarities with those added to the newer version of the guidelines. Conclusion Our method showed its usefulness for completing guidelines recommendations with rules learnt automatically from physicians' prescriptions. It could be used

  11. Selection of Library Automation Systems: A Management Perspective

    OpenAIRE

    Wenxian Zhang

    1998-01-01

    無Selecting automated library systems is a complex and often difficult process that most library administrators will have to go through, and different libraries usually took different approaches. This study is to identify the factors that influence library administrators' decision-making process regarding library automation. The most significant attitude changes between librarians with automated systems already in their libraries and those without automation occurred in the areas of system cos...

  12. Robust automated knowledge capture.

    Energy Technology Data Exchange (ETDEWEB)

    Stevens-Adams, Susan Marie; Abbott, Robert G.; Forsythe, James Chris; Trumbo, Michael Christopher Stefan; Haass, Michael Joseph; Hendrickson, Stacey M. Langfitt

    2011-10-01

    This report summarizes research conducted through the Sandia National Laboratories Robust Automated Knowledge Capture Laboratory Directed Research and Development project. The objective of this project was to advance scientific understanding of the influence of individual cognitive attributes on decision making. The project has developed a quantitative model known as RumRunner that has proven effective in predicting the propensity of an individual to shift strategies on the basis of task and experience related parameters. Three separate studies are described which have validated the basic RumRunner model. This work provides a basis for better understanding human decision making in high consequent national security applications, and in particular, the individual characteristics that underlie adaptive thinking.

  13. Ensuring Resident Competence: A Narrative Review of the Literature on Group Decision Making to Inform the Work of Clinical Competency Committees.

    Science.gov (United States)

    Hauer, Karen E; Cate, Olle Ten; Boscardin, Christy K; Iobst, William; Holmboe, Eric S; Chesluk, Benjamin; Baron, Robert B; O'Sullivan, Patricia S

    2016-05-01

    Background The expectation for graduate medical education programs to ensure that trainees are progressing toward competence for unsupervised practice prompted requirements for a committee to make decisions regarding residents' progress, termed a clinical competency committee (CCC). The literature on the composition of these committees and how they share information and render decisions can inform the work of CCCs by highlighting vulnerabilities and best practices. Objective We conducted a narrative review of the literature on group decision making that can help characterize the work of CCCs, including how they are populated and how they use information. Methods English language studies of group decision making in medical education, psychology, and organizational behavior were used. Results The results highlighted 2 major themes. Group member composition showcased the value placed on the complementarity of members' experience and lessons they had learned about performance review through their teaching and committee work. Group processes revealed strengths and limitations in groups' understanding of their work, leader role, and information-sharing procedures. Time pressure was a threat to the quality of group work. Conclusions Implications of the findings include the risks for committees that arise with homogeneous membership, limitations to available resident performance information, and processes that arise through experience rather than deriving from a well-articulated purpose of their work. Recommendations are presented to maximize the effectiveness of CCC processes, including their membership and access to, and interpretation of, information to yield evidence-based, well-reasoned judgments. PMID:27168881

  14. Driver Behaviour in Highly Automated Driving : An evaluation of the effects of traffic, time pressure, cognitive performance and driver attitudes on decision-making time using a web based testing platform

    OpenAIRE

    Eriksson, Alexander

    2014-01-01

    Driverless cars are a hot topic in today’s industry where several vehicle manufacturers try to create a reliable system for automated driving. The advantages of highly automated vehicles are many, safer roads and a lower environmental impact are some of the arguments for this technology. However, the notion of highly automated cars give rise to a large number of human factor issues regarding the safety and reliability of the automated system as well as concern about the driver’s role in the s...

  15. General practitioners' attitudes and preparedness towards Clinical Decision Support in e-Prescribing (CDS-eP adoption in the West of Ireland: a cross sectional study

    Directory of Open Access Journals (Sweden)

    O'Brien Timothy

    2010-01-01

    Full Text Available Abstract Background Electronic clinical decision support (CDS is increasingly establishing its role in evidence-based clinical practice. Considerable evidence supports its enhancement of efficiency in e-Prescribing, but some controversy remains. This study evaluated the practicality and identified the perceived benefits of, and barriers to, its future adoption in the West of Ireland. Methods This cross sectional study was carried out by means of a 27-part questionnaire sent to 262 registered general practitioners in Counties Galway, Mayo and Roscommon. The survey domains encompassed general information of individual's practice, current use of CDS and the practitioner's attitudes towards adoption of CDS-eP. Descriptive and inferential analyses were performed to analyse the data collected. Results The overall response rate was 37%. Nearly 92% of respondents employed electronic medical records in their practice. The majority acknowledged the value of electronic CDS in improving prescribing quality (71% and reducing prescribing errors (84%. Despite a high degree of unfamiliarity (73%, the practitioners were open to the use of CDS-eP (94% and willing to invest greater resources for its implementation (62%. Lack of a strategic implementation plan (78% is the main perceived barrier to the incorporation of CDS-eP into clinical practice, followed by i lack of financial incentives (70%, ii lack of standardized product software (61%, iii high sensitivity of drug-drug interaction or medication allergy markers (46%, iv concern about overriding physicians' prescribing decisions(44% and v lack of convincing evidence on the systems' effectiveness (22%. Conclusions Despite favourable attitudes towards the adoption of CDS-eP, multiple perceived barriers impede its incorporation into clinical practice. These merit further exploration, taking into consideration the structure of the Irish primary health care system, before CDS-eP can be recommended for routine

  16. Implementation of automated reporting of estimated glomerular filtration rate among Veterans Affairs laboratories: a retrospective study

    Directory of Open Access Journals (Sweden)

    Hall Rasheeda K

    2012-07-01

    Full Text Available Abstract Background Automated reporting of estimated glomerular filtration rate (eGFR is a recent advance in laboratory information technology (IT that generates a measure of kidney function with chemistry laboratory results to aid early detection of chronic kidney disease (CKD. Because accurate diagnosis of CKD is critical to optimal medical decision-making, several clinical practice guidelines have recommended the use of automated eGFR reporting. Since its introduction, automated eGFR reporting has not been uniformly implemented by U. S. laboratories despite the growing prevalence of CKD. CKD is highly prevalent within the Veterans Health Administration (VHA, and implementation of automated eGFR reporting within this integrated healthcare system has the potential to improve care. In July 2004, the VHA adopted automated eGFR reporting through a system-wide mandate for software implementation by individual VHA laboratories. This study examines the timing of software implementation by individual VHA laboratories and factors associated with implementation. Methods We performed a retrospective observational study of laboratories in VHA facilities from July 2004 to September 2009. Using laboratory data, we identified the status of implementation of automated eGFR reporting for each facility and the time to actual implementation from the date the VHA adopted its policy for automated eGFR reporting. Using survey and administrative data, we assessed facility organizational characteristics associated with implementation of automated eGFR reporting via bivariate analyses. Results Of 104 VHA laboratories, 88% implemented automated eGFR reporting in existing laboratory IT systems by the end of the study period. Time to initial implementation ranged from 0.2 to 4.0 years with a median of 1.8 years. All VHA facilities with on-site dialysis units implemented the eGFR software (52%, p Conclusions The VHA did not have uniform implementation of automated e

  17. New continuous air pumping technique to improve clinical outcomes of descemet-stripping automated endothelial keratoplasty in asian patients with previous ahmed glaucoma valve implantation.

    Directory of Open Access Journals (Sweden)

    Chang-Min Liang

    Full Text Available BACKGROUND: To evaluate the outcomes of Descemet-stripping automated endothelial keratoplasty (DSAEK with the use of continuous air pumping technique in Asian eyes with previous Ahmed glaucoma valve implantation. METHODS: The DSAEK procedure was modified in that complete air retention of the anterior chamber was maintained for 10 min using continuous air pumping at 30 mm Hg. The primary outcome measurement was graft survival, and postoperative clinical features including, rate of graft detachment, endothelial cell count, intraocular pressure (IOP, surgical time and cup/disc ratio were also recorded. RESULTS: A total of 13 eyes of 13 patients which underwent modified DSAEK and 6 eyes of 6 patients which underwent conventional DSAEK were included. There was a significant difference in graft survival curves between two groups (P = 0.029; the 1-year graft survival rates were estimated as 100% and 66.7% for patients with modified DSAEK and those with traditional DSAEK, respectively. The rate of graft detachment were 0% and 33.3% for the modified DSAEK and conventional DSAEK groups, respectively (P = 0.088. The significantly lowered surgical time for air tamponade was noted in the modified DSAEK group compared to that in the conventional DSAEK group [median (IQR: 10.0 (10.0, 10.0 min vs. 24.5 (22.0, 27.0 min; P<0.001] Postoperatively, patients in the modified DSAEK group had significantly lower IOP as compared to the conventional DSAEK group [12.0 (11.0, 15.0 mm Hg vs. 16.0 (15.0, 18.0 mm Hg; P = 0.047]. Modified DSAEK patients had higher endothelial cell counts as compared to conventional DSAEK patients [2148.0 (1964.0, 2218.0 vs. 1529.0 (713.0, 2014.0], but the difference did not reach statistical significance (P = 0.072. CONCLUSIONS: New continuous air pumping technique in DSAEK can be performed safely and effectively in patients with prior GDDs placement who have corneal failure.

  18. Do different clinical evidence bases lead to discordant health-technology assessment decisions? An in-depth case series across three jurisdictions

    Directory of Open Access Journals (Sweden)

    Spinner DS

    2013-01-01

    Full Text Available Daryl S Spinner,1 Julie Birt,2 Jeffrey W Walter,1 Lee Bowman,2 Josephine Mauskopf,1 Michael F Drummond,3 Catherine Copley-Merriman11RTI Health Solutions, Research Triangle Park, NC, USA; 2Eli Lilly and Company, Indianapolis, IN, United States; 3University of York, York, UKBackground: Health-technology assessment (HTA plays an important role in informing drug-reimbursement decision-making in many countries. HTA processes for the Pharmaceutical Benefits Advisory Committee (PBAC in Australia, the Common Drug Review (CDR in Canada, and the National Institute for Health and Clinical Excellence (NICE in England and Wales are among the most established in the world. In this study, we performed nine in-depth case studies to assess whether different clinical evidence bases may have influenced listing recommendations made by PBAC, CDR, and NICE.Methods: Nine drugs were selected for which the three agencies had provided listing recommendations for the same indication between 2007 and 2010. We reviewed the evidence considered for each listing recommendation, identified the similarities and differences among the clinical evidence bases considered, and evaluated the extent to which different clinical evidence bases could have contributed to different decisions based on HTA body comments and public assessment of the evidence.Results: HTA agencies reached the same recommendation for reimbursement (recommended for listing for four drugs and different recommendations for five drugs. In all cases, each agency used different evidence bases in their recommendations. The agencies considered overlapping sets of clinical comparators and trials when evaluating the same drug. While PBAC and NICE considered indirect and/or mixed-treatment comparisons, CDR did not. In some cases, CDR and/or NICE excluded trials from review if the drug and/or the comparator were not administered according to the relevant marketing authorization.Conclusions: In the listing recommendations

  19. Automation Security

    OpenAIRE

    Mirzoev, Dr. Timur

    2014-01-01

    Web-based Automated Process Control systems are a new type of applications that use the Internet to control industrial processes with the access to the real-time data. Supervisory control and data acquisition (SCADA) networks contain computers and applications that perform key functions in providing essential services and commodities (e.g., electricity, natural gas, gasoline, water, waste treatment, transportation) to all Americans. As such, they are part of the nation s critical infrastructu...

  20. Cardio Online Reader/COR: A Web 2.0-Based Tool Aimed at Clinical Decision-Making Support in Cardiology

    Czech Academy of Sciences Publication Activity Database

    Papíková, Vendula; Zvolský, Miroslav

    Heidelberg: Springer Science-Business Media, 2012 - (Kostkova, P.; Szomszor, M.; Fowler, D.), s. 122-127. (Lecture Notes of the Institute for Computer Sciences, Social-Informatics and Telecommunications Engineering . 91). ISBN 978-3-642-29261-3. ISSN 1867-8211. [eHealth 2011. International Conference /4./. Málaga (ES), 21.11.2011-23.11.2011] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : EBM * Web 2.0 * medical information sources * clinical decision-making support Subject RIV: IN - Informatics, Computer Science

  1. Feasibility of integrating a clinical decision support tool into an existing computerized physician order entry system to increase seasonal influenza vaccination in the emergency department.

    Science.gov (United States)

    Venkat, Arvind; Chan-Tompkins, Noreen H; Hegde, Gajanan G; Chuirazzi, David M; Hunter, Roger; Szczesiul, Jillian M

    2010-08-23

    While emergency department (ED) seasonal influenza vaccination programs are feasible, reported implementation barriers include added staffing requirements to identify eligible patients and getting busy ED personnel to order and provide vaccination. We present a prospective, observational trial of integrating a clinical decision support tool into an existing ED computerized physician order entry (CPOE) system to increase ED seasonal influenza vaccination without added staffing resources, the operational barriers identified to program implementation, the revenue generated and data on opportunities for future quality improvement. Compared to the comparable pre-protocol period, ED influenza vaccination rose by 17.5% with a resultant profit margin of 34.5%. PMID:20620167

  2. Clinical Decision Support Using Electronic Medical Records: For the Improvement of Diabetes Care and Proper Use of Insulin for Inpatients.

    Science.gov (United States)

    Seto, Ryoma; Wakabayashi, Susumu

    2015-01-01

    The aim of the study is to develop a scheme of a decision support system concerning insulin intervention for inpatients. Transaction data for 32,637 inpatients were collected from the EMR. As a result, antidiabetic agents were not taken by 38.9%-41.7% of patients with a Disease Complicated by DM. It is recommended that the EMR should provide a suggestion about insulin level for diseases with DM as a complicating factor. PMID:26262263

  3. A collaborative framework for contributing DICOM RT PHI (Protected Health Information) to augment data mining in clinical decision support

    Science.gov (United States)

    Deshpande, Ruchi; Thuptimdang, Wanwara; DeMarco, John; Liu, Brent J.

    2014-03-01

    We have built a decision support system that provides recommendations for customizing radiation therapy treatment plans, based on patient models generated from a database of retrospective planning data. This database consists of relevant metadata and information derived from the following DICOM objects - CT images, RT Structure Set, RT Dose and RT Plan. The usefulness and accuracy of such patient models partly depends on the sample size of the learning data set. Our current goal is to increase this sample size by expanding our decision support system into a collaborative framework to include contributions from multiple collaborators. Potential collaborators are often reluctant to upload even anonymized patient files to repositories outside their local organizational network in order to avoid any conflicts with HIPAA Privacy and Security Rules. We have circumvented this problem by developing a tool that can parse DICOM files on the client's side and extract de-identified numeric and text data from DICOM RT headers for uploading to a centralized system. As a result, the DICOM files containing PHI remain local to the client side. This is a novel workflow that results in adding only relevant yet valuable data from DICOM files to the centralized decision support knowledge base in such a way that the DICOM files never leave the contributor's local workstation in a cloud-based environment. Such a workflow serves to encourage clinicians to contribute data for research endeavors by ensuring protection of electronic patient data.

  4. Factors that influence the clinical decision-making of rehabilitation professionals in long-term care settings.

    Science.gov (United States)

    Wainwright, Susan Flannery; McGinnis, Patricia Quinn

    2009-01-01

    The purpose of this qualitative research was to evaluate the reasoning of clinicians practicing in long-term care facilities and to explore factors influencing their professional development. Eighteen participants were recruited from eight clinical sites and included seven occupational therapists, eight physical therapists, and three speech therapists distributed across three groups relative to experience. Nonparticipant observation and videotape of therapist-patient interactions were used in semi-structured interviews with each participant. Qualitative data analysis software was used during a process of open and axial coding, followed by thematic analysis. The facilitory and inhibitory factors that affect clinical reasoning and professional development were identified. Rehabilitation professionals in long-term care demonstrated clinical reasoning within the context of patient-centered goals. Well-developed and explicit programs for mentorship, professional development, and continuing education fostered their clinical reasoning abilities. Participants perceived that these factors were vital to achieving optimal patient outcomes. PMID:19753425

  5. Developing public health clinical decision support systems (CDSS) for the outpatient community in New York City: our experience

    OpenAIRE

    Singer Jesse; Anane Sheila; Taverna John; Amirfar Sam

    2011-01-01

    Abstract Background Developing a clinically relevant set of quality measures that can be effectively used by an electronic health record (EHR) is difficult. Whether it is achieving internal consensus on relevant priority quality measures, communicating to EHR vendors' whose programmers generally lack clinical contextual knowledge, or encouraging implementation of EHR that meaningfully impacts health outcomes, the path is challenging. However, greater transparency of population health, better ...

  6. Detection of DNA Aneuploidy in Exfoliated Airway Epithelia Cells of Sputum Specimens by the Automated Image Cytometry and Its Clinical Value in the Identification of Lung Cancer

    Institute of Scientific and Technical Information of China (English)

    杨健; 周宜开

    2004-01-01

    To evaluate the value of detecton of DNA aneuploidy in exfoliated airway epithelia cells of sputum specimens by the automated image cytometry for the identification of lung cancer, 100patients were divided into patient group (50 patients with lung cancer)and control group (30 patients with tuberculosis and 20 healthy people). Sputum was obtained for the quantitative analysis of DNA content of exfoliated airway epithelial cells with the automated image cytometry, together with the examinations of brush cytology and conventional sputum cytology. Our results showed that DNA aneuploidy (DI>2.5 or 5c) was found in 20 out of 50 sputum samples of lung cancer, 1 out of 30 sputum samples from tuberculosis patients, and none of 20 sputum samples from healthy people. The positive rates of conventional sputum cytology and brush cytology were 16 % and 32 %,which was lower than that of DNA aneuploidy detection by the automated image cytometry (P<0.01 ,P>0.05). Our study showed that automated image cytometry, which uses DNA aneuploidy as a marker for tumor, can detect the malignant cells in sputum samples of lung cancer and it is a sensitive and specific method serving as a complement for the diagnosis of lung cancer.

  7. ESMO Consensus Guidelines for management of patients with colon and rectal cancer. a personalized approach to clinical decision making

    DEFF Research Database (Denmark)

    Schmoll, H J; Van Cutsem, E; Stein, A;

    2012-01-01

    Colorectal cancer (CRC) is the most common tumour type in both sexes combined in Western countries. Although screening programmes including the implementation of faecal occult blood test and colonoscopy might be able to reduce mortality by removing precursor lesions and by making diagnosis...... patients by a combination of chemotherapy and surgery. Treatment decisions must be based on the available evidence, which has been the basis for this consensus conference-based guideline delivering a clear proposal for diagnostic and treatment measures in each stage of rectal and colon cancer...

  8. Data-mining to build a knowledge representation store for clinical decision support. Studies on curation and validation based on machine performance in multiple choice medical licensing examinations.

    Science.gov (United States)

    Robson, Barry; Boray, Srinidhi

    2016-06-01

    Extracting medical knowledge by structured data mining of many medical records and from unstructured data mining of natural language source text on the Internet will become increasingly important for clinical decision support. Output from these sources can be transformed into large numbers of elements of knowledge in a Knowledge Representation Store (KRS), here using the notation and to some extent the algebraic principles of the Q-UEL Web-based universal exchange and inference language described previously, rooted in Dirac notation from quantum mechanics and linguistic theory. In a KRS, semantic structures or statements about the world of interest to medicine are analogous to natural language sentences seen as formed from noun phrases separated by verbs, prepositions and other descriptions of relationships. A convenient method of testing and better curating these elements of knowledge is by having the computer use them to take the test of a multiple choice medical licensing examination. It is a venture which perhaps tells us almost as much about the reasoning of students and examiners as it does about the requirements for Artificial Intelligence as employed in clinical decision making. It emphasizes the role of context and of contextual probabilities as opposed to the more familiar intrinsic probabilities, and of a preliminary form of logic that we call presyllogistic reasoning. PMID:27089305

  9. Development of a clinical decision support system using genetic algorithms and Bayesian classification for improving the personalised management of women attending a colposcopy room.

    Science.gov (United States)

    Bountris, Panagiotis; Topaka, Elena; Pouliakis, Abraham; Haritou, Maria; Karakitsos, Petros; Koutsouris, Dimitrios

    2016-06-01

    Cervical cancer (CxCa) is often the result of underestimated abnormalities in the test Papanicolaou (Pap test). The recent advances in the study of the human papillomavirus (HPV) infection (the necessary cause for CxCa development) have guided clinical practice to add HPV related tests alongside the Pap test. In this way, today, HPV DNA testing is well accepted as an ancillary test and it is used for the triage of women with abnormal findings in cytology. However, these tests are either highly sensitive or highly specific, and therefore none of them provides an optimal solution. In this Letter, a clinical decision support system based on a hybrid genetic algorithm - Bayesian classification framework is presented, which combines the results of the Pap test with those of the HPV DNA test in order to exploit the benefits of each method and produce more accurate outcomes. Compared with the medical tests and their combinations (co-testing), the proposed system produced the best receiver operating characteristic curve and the most balanced combination among sensitivity and specificity in detecting high-grade cervical intraepithelial neoplasia and CxCa (CIN2+). This system may support decision-making for the improved management of women who attend a colposcopy room following a positive test result. PMID:27382484

  10. The emerging role of histology in the choice of first-line treatment of advanced non-small cell lung cancer: implication in the clinical decision-making.

    Science.gov (United States)

    Rossi, Antonio; Maione, Paolo; Bareschino, Maria Anna; Schettino, Clorinda; Sacco, Paola Claudia; Ferrara, Marianna Luciana; Castaldo, Vincenzo; Gridelli, Cesare

    2010-01-01

    Lung cancer is the leading cause of cancer mortality worldwide. Non-small cell lung cancer (NSCLC), accounting for about 85% of all lung cancers, includes squamous carcinoma, adenocarcinoma and undifferentiated large cell carcinoma. The majority of patients have advanced disease at diagnosis, and medical treatment is the cornerstone of management. Several randomized trials comparing third-generation platinum-based doublets concluded that all such combinations are comparable in their clinical efficacy, failing to document a difference based on histology. However, recent evidences, arising from the availability of pemetrexed, have shown that histology represents an important variable in the decision making. The major progresses in the understanding cancer biology and mechanism of oncogenesis have allowed the development of several potential molecular targets for cancer treatment such as vascular growth factor and its receptors and epidermal growth factor receptor. Targeted drugs seem to be safer or more effective in a specific histology subtype. All of these data have led to choose the optimal first-line treatment of advanced NSCLC based on histologic diagnosis. However, this scenario raises a diagnostic issue: a specific diagnosis of NSCLC histologic subtype is mandatory. This review will discuss these new evidences in the first-line treatment of advanced NSCLC and their implication in the current clinical decision-making. PMID:20156162

  11. Barriers to implementation of a computerized decision support system for depression: an observational report on lessons learned in "real world" clinical settings

    Directory of Open Access Journals (Sweden)

    Sunderajan Prabha

    2009-01-01

    Full Text Available Abstract Background Despite wide promotion, clinical practice guidelines have had limited effect in changing physician behavior. Effective implementation strategies to date have included: multifaceted interventions involving audit and feedback, local consensus processes, marketing; reminder systems, either manual or computerized; and interactive educational meetings. In addition, there is now growing evidence that contextual factors affecting implementation must be addressed such as organizational support (leadership procedures and resources for the change and strategies to implement and maintain new systems. Methods To examine the feasibility and effectiveness of implementation of a computerized decision support system for depression (CDSS-D in routine public mental health care in Texas, fifteen study clinicians (thirteen physicians and two advanced nurse practitioners participated across five sites, accruing over 300 outpatient visits on 168 patients. Results Issues regarding computer literacy and hardware/software requirements were identified as initial barriers. Clinicians also reported concerns about negative impact on workflow and the potential need for duplication during the transition from paper to electronic systems of medical record keeping. Conclusion The following narrative report based on observations obtained during the initial testing and use of a CDSS-D in clinical settings further emphasizes the importance of taking into account organizational factors when planning implementation of evidence-based guidelines or decision support within a system.

  12. Intention to adopt clinical decision support systems in a developing country: effect of Physician’s perceived professional autonomy, involvement and belief: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Sambasivan Murali

    2012-12-01

    Full Text Available Abstract Background Computer-based clinical decision support systems (CDSS are regarded as a key element to enhance decision-making in a healthcare environment to improve the quality of medical care delivery. The concern of having new CDSS unused is still one of the biggest issues in developing countries for the developers and implementers of clinical IT systems. The main objectives of this study are to determine whether (1 the physician’s perceived professional autonomy, (2 involvement in the decision to implement CDSS and (3 the belief that CDSS will improve job performance increase the intention to adopt CDSS. Four hypotheses were formulated and tested. Methods A questionnaire-based survey conducted between July 2010 and December 2010. The study was conducted in seven public and five private hospitals in Kuala Lumpur, Malaysia. Before contacting the hospitals, necessary permission was obtained from the Ministry of Health, Malaysia and the questionnaire was vetted by the ethics committee of the ministry. Physicians working in 12 hospitals from 10 different specialties participated in the study. The sampling method used was stratified random sampling and the physicians were stratified based on the specialty. A total of 450 physicians were selected using a random number generator. Each of these physicians was given a questionnaire and out of 450 questionnaires, 335 (response rate – 74% were returned and 309 (69% were deemed usable. Results The hypotheses were tested using Structural Equation Modeling (SEM. Salient results are: (1 Physicians’ perceived threat to professional autonomy lowers the intention to use CDSS (p Conclusion The proposed model with the three main constructs (physician’s professional characteristic, involvement and belief explains 47% of the variance in the intention to use CDSS. This is significantly higher than the models addressed so far. The results will have a major impact in implementing CDSS in developing

  13. The limitations of using the existing TAM in adoption of clinical decision support system in hospitals: An empirical study in Malaysia

    Directory of Open Access Journals (Sweden)

    Pouyan Esmaeilzadeh

    2014-04-01

    Full Text Available The technology acceptance model (TAM has been widely used to study user acceptance of new computer technologies. Previous studies claimed that future technology acceptance research should explore other additional explanatory variables, which may affect the originally proposed constructs of the TAM. The use of information technology in the health care sector and especially in hospitals offers great potential for improving the performance of physicians, increasing the quality of services and also reducing the organizational expenses. However, the main challenge that arises according to the literature is whether healthcare professionals are willing to adopt and use clinical information technology while performing their tasks. Although adoption of various information technologies has been studied using the technology acceptance model (TAM, the study of technology acceptance for professional groups (such as physicians has been limited. Physician adoption of clinical information technology is important for its successful implementation. Therefore, the purpose of this study is to gain a better insight about factors affecting physicians’ acceptance of clinical decision support systems (CDSS in a hospital setting. The results reflect the importance of perceived threat to professional autonomy, perceived interactivity with clinical IT, perceived usefulness and perceived ease of use in determining physicians’ intention to use CDSS.

  14. Building a web-based tool to support clinical decisions in the control of Chlamydia trachomatis and Neisseria gonorrhoeae infections.

    Science.gov (United States)

    Zhao, Kun; Qiu, Fasheng; Chen, Guantao

    2013-12-20

    Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) are the agents of two common, sexually transmitted diseases afflicting women in the United States (http://www.cdc.gov). We designed a novel web-based application that offers simple recommendations to help optimize medical outcomes with CT and GC prevention and control programs. This application takes population groups, prevalence rates, parameters for available screening assays and treatment regimens (costs, sensitivity, and specificity), as well as budget limits as inputs. Its output suggests optimal screening and treatment strategies for selected at-risk groups, commensurate with the clinic's budget allocation. Development of this tool illustrates how a clinical informatics application based on rigorous mathematics might have a significant impact on real-world clinical issues. PMID:24564848

  15. Unmet needs in automated cytogenetics

    International Nuclear Information System (INIS)

    Though some, at least, of the goals of automation systems for analysis of clinical cytogenetic material seem either at hand, like automatic metaphase finding, or at least likely to be met in the near future, like operator-assisted semi-automatic analysis of banded metaphase spreads, important areas of cytogenetic analsis, most importantly the determination of chromosomal aberration frequencies in populations of cells or in samples of cells from people exposed to environmental mutagens, await practical methods of automation. Important as are the clinical diagnostic applications, it is apparent that increasing concern over the clastogenic effects of the multitude of potentially clastogenic chemical and physical agents to which human populations are being increasingly exposed, and the resulting emergence of extensive cytogenetic testing protocols, makes the development of automation not only economically feasible but almost mandatory. The nature of the problems involved, and acutal of possible approaches to their solution, are discussed

  16. Cyborg practices: call-handlers and computerised decision support systems in urgent and emergency care.

    Science.gov (United States)

    Pope, Catherine; Halford, Susan; Turnbull, Joanne; Prichard, Jane

    2014-06-01

    This article draws on data collected during a 2-year project examining the deployment of a computerised decision support system. This computerised decision support system was designed to be used by non-clinical staff for dealing with calls to emergency (999) and urgent care (out-of-hours) services. One of the promises of computerised decisions support technologies is that they can 'hold' vast amounts of sophisticated clinical knowledge and combine it with decision algorithms to enable standardised decision-making by non-clinical (clerical) staff. This article draws on our ethnographic study of this computerised decision support system in use, and we use our analysis to question the 'automated' vision of decision-making in healthcare call-handling. We show that embodied and experiential (human) expertise remains central and highly salient in this work, and we propose that the deployment of the computerised decision support system creates something new, that this conjunction of computer and human creates a cyborg practice. PMID:24810726

  17. General practitioners' and nurses' experiences of using computerised decision support in screening for diabetic foot disease: implementing Scottish Clinical Information - Diabetes Care in routine clinical practice

    Directory of Open Access Journals (Sweden)

    Fay Crawford

    2010-12-01

    Conclusions Adoption of the SCI-DC foot assessment tool in primary care is not perceived as clinically necessary. Although information recorded by specialist services on SCI-DC is helpful, important structural barriers to its implementation mean the potential benefits associated with its use are unlikely to be realised; greater engagement with primary care priorities for diabetes management is needed to assist its successful implementation and adoption.

  18. Producing the BEANs needed for person-centred healthcare decision making requires translating the wisdom of the clinical crowd

    DEFF Research Database (Denmark)

    Kaltoft, Mette Kjer; Eiring, Øystein; Nielsen, Jesper Bo;

    in which an individual's preferences over the multiple criteria that matter to them are synthesised with the Best Estimate Available Now (at the point of decision) for how well each of the available options will perform on each criterion. Conventional evidence-based approaches can meet the latter...... (‘living’) production of BEANs, within a Bayesian framework and by a process that is ARAPAN - As Rigorous As Practical And Necessary. This will involve the systematic elicitation and analysis of the potential ‘big data’ that expert beliefs collectively represent, as well as the exploitation...... events, given the known existence of, and differential concern with, effects on sexual, and other functions. Working to the standards appropriate to practice as opposed to science, and simultaneously increasing the range of source inputs to include expert beliefs, is essential to give such modelling...

  19. Under the radar: how unexamined biases in decision-making processes in clinical interactions can contribute to health care disparities.

    Science.gov (United States)

    Dovidio, John F; Fiske, Susan T

    2012-05-01

    Several aspects of social psychological science shed light on how unexamined racial/ethnic biases contribute to health care disparities. Biases are complex but systematic, differing by racial/ethnic group and not limited to love-hate polarities. Group images on the universal social cognitive dimensions of competence and warmth determine the content of each group's overall stereotype, distinct emotional prejudices (pity, envy, disgust, pride), and discriminatory tendencies. These biases are often unconscious and occur despite the best intentions. Such ambivalent and automatic biases can influence medical decisions and interactions, systematically producing discrimination in health care and ultimately disparities in health. Understanding how these processes may contribute to bias in health care can help guide interventions to address racial and ethnic disparities in health. PMID:22420809

  20. Decision and decision makers

    Directory of Open Access Journals (Sweden)

    Anuta Porutiu

    2010-12-01

    Full Text Available In the current economic context, decision making requires complex and multiple actions on the part of the policy makers, who are more challenged than in previous situations, due to the crisis that we are facing. Decision problems cannot be solved by focusing on manager’s own experience or intuition, but require constant adaptation of the methods used effectively in the past to new challenges. Thus, a systemic analysis and modeling of arising issues is required, resulting in the stringent use of Decision Support Systems (DSS, as a necessity in a competitive environment. DSS optimize the situation by getting a timely decision because the decision making process must acquire, process and interpret an even larger amount of data in the shortest possible time. A solution for this purpose is the artificial intelligence systems, in this case Decision Support Systems (DSS, used in a wider area due to expansion of all the new information technologies in decisionmaking processes. These substantial cyber innovations have led to a radical shift in the relationship between enterprise success and quality of decisions made by managers.

  1. Evaluation of Three Automated Nucleic Acid Extraction Systems for Identification of Respiratory Viruses in Clinical Specimens by Multiplex Real-Time PCR

    OpenAIRE

    2014-01-01

    A total of 84 nasopharyngeal swab specimens were collected from 84 patients. Viral nucleic acid was extracted by three automated extraction systems: QIAcube (Qiagen, Germany), EZ1 Advanced XL (Qiagen), and MICROLAB Nimbus IVD (Hamilton, USA). Fourteen RNA viruses and two DNA viruses were detected using the Anyplex II RV16 Detection kit (Seegene, Republic of Korea). The EZ1 Advanced XL system demonstrated the best analytical sensitivity for all the three viral strains. The nucleic acids extrac...

  2. A pilot study for development of a novel tool for clinical decision making to identify fallers among ophthalmic patients

    OpenAIRE

    Melillo, P; Orrico, A; Attanasio, M.; Rossi, S.; Pecchia, L; Chirico, F.; F. Testa; Simonelli, F.

    2015-01-01

    Background Falls in the elderly is a major problem. Although falls have a multifactorial etiology, a commonly cited cause of falls in older people is poor vision. This study proposes a method to discriminate fallers and non-fallers among ophthalmic patients, based on data-mining algorithms applied to health and socio-demographic information. Methods A group of 150 subjects aged 55 years and older, recruited at the Eye Clinic of the Second University of Naples, underwent a baseline ophthalmic ...

  3. Conditional independence relations among biological markers may improve clinical decision as in the case of triple negative breast cancers

    OpenAIRE

    Biganzoli Elia; Coradini Danila; Stefanini Federico M

    2009-01-01

    Abstract The associations existing among different biomarkers are important in clinical settings because they contribute to the characterisation of specific pathways related to the natural history of the disease, genetic and environmental determinants. Despite the availability of binary/linear (or at least monotonic) correlation indices, the full exploitation of molecular information depends on the knowledge of direct/indirect conditional independence (and eventually causal) relationships amo...

  4. Non-Patient-Based Clinical Licensure Examination for Dentistry in Minnesota: Significance of Decision and Description of Process.

    Science.gov (United States)

    Mills, Eric A

    2016-06-01

    In recent years in the United States, there has been heightened interest in offering clinical licensure examination (CLE) alternatives to the live patient-based method in dentistry. Fueled by ethical concerns of faculty members at the University of Minnesota School of Dentistry, the state of Minnesota's Board of Dentistry approved a motion in 2009 to provide two CLE options to the school's future predoctoral graduates: a patient-based one, administered by the Central Regional Dental Testing Service, and a non-patient-based one administered by the National Dental Examining Board of Canada (NDEB). The validity of the NDEB written exam and objective structured clinical exam (OSCE) has been verified in a multi-year study. Via five-option, one-best-answer, multiple-choice questions in the written exam and extended match questions with up to 15 answer options in the station-based OSCE, competent candidates are distinguished from those who are incompetent in their didactic knowledge and clinical critical thinking and judgment across all dental disciplines. The action had the additional effects of furthering participation of Minnesota Board of Dentistry members in the University of Minnesota School of Dentistry's competency-based curriculum, of involving the school's faculty in NDEB item development workshops, and, beginning in 2018, of no longer permitting the patient-based CLE option on site. The aim of this article is to describe how this change came about and its effects. PMID:27251345

  5. Automated Budget System

    Data.gov (United States)

    Department of Transportation — The Automated Budget System (ABS) automates management and planning of the Mike Monroney Aeronautical Center (MMAC) budget by providing enhanced capability to plan,...

  6. Decision and decision makers

    OpenAIRE

    Anuta Porutiu

    2010-01-01

    In the current economic context, decision making requires complex and multiple actions on the part of the policy makers, who are more challenged than in previous situations, due to the crisis that we are facing. Decision problems cannot be solved by focusing on manager’s own experience or intuition, but require constant adaptation of the methods used effectively in the past to new challenges. Thus, a systemic analysis and modeling of arising issues is required, resulting in the stringent use ...

  7. Moving beyond the pros and cons of automating cognitive testing in pathological aging and dementia: the case for equal opportunity.

    Science.gov (United States)

    Wesnes, Keith A

    2014-01-01

    The lack of progress over the last decade in developing treatments for Alzheimer's disease has called into question the quality of the cognitive assessments used while also shifting the emphasis from treatment to prophylaxis by studying the disorder at earlier stages, even prior to the development of cognitive symptoms. This has led various groups to seek cognitive tests which are more sensitive than those currently used and which can be meaningfully administered to individuals with mild or even no cognitive impairment. Although computerized tests have long been used in this field, they have made little inroads compared with non-automated tests. This review attempts to put in perspective the relative utilities of automated and non-automated tests of cognitive function in therapeutic trials of pathological aging and the dementias. Also by a review of the automation of cognitive tests over the last 150 years, it is hoped that the notion that such procedures are novel compared with pencil-and-paper testing will be dispelled. Furthermore, data will be presented to illustrate that older individuals and patients with dementia are neither stressed nor disadvantaged when tested with appropriately developed computerized methods. An important aspect of automated testing is that it can assess all aspects of task performance, including the speed of cognitive processes, and data are presented on the advantages this can confer in clinical trials. The ultimate objectives of the review are to encourage decision making in the field to move away from the automated/non-automated dichotomy and to develop criteria pertinent to each trial against which all available procedures are evaluated. If we are to make serious progress in this area, we must use the best tools available, and the evidence suggests that automated testing has earned the right to be judged against the same criteria as non-automated tests. PMID:25478021

  8. Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance

    Directory of Open Access Journals (Sweden)

    Knutson Gary A

    2005-07-01

    Full Text Available Abstract Background Leg-length inequality is most often divided into two groups: anatomic and functional. Part I of this review analyses data collected on anatomic leg-length inequality relative to prevalence, magnitude, effects and clinical significance. Part II examines the functional "short leg" including anatomic-functional relationships, and provides an outline for clinical decision-making. Methods Online database – Medline, CINAHL and MANTIS – and library searches for the time frame of 1970–2005 were done using the term "leg-length inequality". Results and Discussion Using data on leg-length inequality obtained by accurate and reliable x-ray methods, the prevalence of anatomic inequality was found to be 90%, the mean magnitude of anatomic inequality was 5.2 mm (SD 4.1. The evidence suggests that, for most people, anatomic leg-length inequality does not appear to be clinically significant until the magnitude reaches ~ 20 mm (~3/4". Conclusion Anatomic leg-length inequality is near universal, but the average magnitude is small and not likely to be clinically significant.

  9. Comparison of Cone-Beam Computed Tomography and Periapical Radiography in Predicting Treatment Decision for Periapical Lesions: A Clinical Study

    Directory of Open Access Journals (Sweden)

    Ashok Balasundaram

    2012-01-01

    Full Text Available Objectives. To compare the ability of endodontists to determine the size of apical pathological lesions and select the most appropriate choice of treatment based on lesions’ projected image characteristics using 2 D and 3 D images. Study Design. Twenty-four subjects were selected. Radiographic examination of symptomatic study teeth with an intraoral periapical radiograph revealed periapical lesions equal to or greater than 3 mm in the greatest diameter. Cone-beam Computed tomography (CBCT images were made of the involved teeth after the intraoral periapical radiograph confirmed the size of lesion to be equal to greater than 3 mm. Six observers (endodontists viewed both the periapical and CBCT images. Upon viewing each of the images from the two imaging modalities, observers (1 measured lesion size and (2 made decisions on treatment based on each radiograph. Chi-square test was used to look for differences in the choice of treatment among observers. Results. No significant difference was noted in the treatment plan selected by observers using the two modalities (χ2(3=.036, P>0.05. Conclusion. Lesion size and choice of treatment of periapical lesions based on CBCT radiographs do not change significantly from those made on the basis of 2 D radiographs.

  10. Evaluation of Stream Mining Classifiers for Real-Time Clinical Decision Support System: A Case Study of Blood Glucose Prediction in Diabetes Therapy

    Directory of Open Access Journals (Sweden)

    Simon Fong

    2013-01-01

    Full Text Available Earlier on, a conceptual design on the real-time clinical decision support system (rt-CDSS with data stream mining was proposed and published. The new system is introduced that can analyze medical data streams and can make real-time prediction. This system is based on a stream mining algorithm called VFDT. The VFDT is extended with the capability of using pointers to allow the decision tree to remember the mapping relationship between leaf nodes and the history records. In this paper, which is a sequel to the rt-CDSS design, several popular machine learning algorithms are investigated for their suitability to be a candidate in the implementation of classifier at the rt-CDSS. A classifier essentially needs to accurately map the events inputted to the system into one of the several predefined classes of assessments, such that the rt-CDSS can follow up with the prescribed remedies being recommended to the clinicians. For a real-time system like rt-CDSS, the major technological challenges lie in the capability of the classifier to process, analyze and classify the dynamic input data, quickly and upmost reliably. An experimental comparison is conducted. This paper contributes to the insight of choosing and embedding a stream mining classifier into rt-CDSS with a case study of diabetes therapy.

  11. [Use of translational database at clinical department].

    Science.gov (United States)

    Højfeldt, Anne Dirks; Johnsen, Hans E; Bøgsted, Martin; Schmitz, Alexander; Fogd, Kirsten; Pilgaard, Linda; Nyegaard, Mette; Dybkaer, Karen; Bukh, Anne

    2010-07-12

    In haematology it is assumed that integrative analysis of global gene expression, protein and cell profiles as well as clinical data will lead to the development of new diagnostic, prognostic and predictive methods. A translational database system registering and combining all data and clinical observations about the patient is therefore needed. It is expected that along with automated prediction and prognosis tools, such a database system may have the potential to assist the development of new machine-based diagnostic decision-making processes. PMID:20615376

  12. Developing public health clinical decision support systems (CDSS for the outpatient community in New York City: our experience

    Directory of Open Access Journals (Sweden)

    Singer Jesse

    2011-09-01

    Full Text Available Abstract Background Developing a clinically relevant set of quality measures that can be effectively used by an electronic health record (EHR is difficult. Whether it is achieving internal consensus on relevant priority quality measures, communicating to EHR vendors' whose programmers generally lack clinical contextual knowledge, or encouraging implementation of EHR that meaningfully impacts health outcomes, the path is challenging. However, greater transparency of population health, better accountability, and ultimately improved health outcomes is the goal and EHRs afford us a realistic chance of reaching it in a scalable way. Method In this article, we summarize our experience as a public health government agency with developing measures for a public health oriented EHR in New York City in partnership with a commercial EHR vendor. Results From our experience, there are six key lessons that we share in this article that we believe will dramatically increase the chance of success. First, define the scope and build consensus. Second, get support from executive leadership. Third, find an enthusiastic and competent software partner. Fourth, implement a transparent operational strategy. Fifth, create and test the EHR system with real life scenarios. Last, seek help when you need it. Conclusions Despite the challenges, we encourage public health agencies looking to build a similarly focused public health EHR to create one both for improved individual patient as well as the larger population health.

  13. Preserving Architectural Decisions through Architectural Patterns

    OpenAIRE

    Thon That, Minh Tu; Sadou, Salah; Oquendo, F.; Fleurquin, R

    2014-01-01

    International audience Architectural decisions have emerged as a means to maintain the quality of the architecture during its evolution. One of the most important de-cisions made by architects are those about the design approach such as the use of patterns or styles in the architecture. The structural nature of this type of decisions give them the potential to be controlled systematically. In the litera-ture, there are some works on the automation of architectural decision violation checki...

  14. Provenance of Decisions in Emergency Response Environments

    OpenAIRE

    Naja, Iman; Moreau, Luc; Rogers, Alex

    2010-01-01

    Mitigating the devastating ramifications of major disasters requires emergency workers to respond in a maximally efficient way. Information systems can improve their efficiency by organizing their efforts and automating many of their decisions. However, absence of documenting how decisions were made by the system prevents decisions from being reviewed to check the reasons for their making or their compliance with policies. We apply the concept of provenance to decision making in emergency res...

  15. Computer decision support software safely improves glycemic control in the burn intensive care unit: a randomized controlled clinical study

    Science.gov (United States)

    Mann, Elizabeth A.; Jones, John A.; Wolf, Steven E.; Wade, Charles E.

    2011-01-01

    Objective The optimal method for glycemic control in the critically burned patient is unknown. The purpose of this randomized controlled study was to determine the safety and efficacy of computer decision support software (CDSS) to control serum glucose concentration in a burn intensive care unit. Methods Eighteen adult burn/trauma patients receiving continuous insulin infusion were initially randomized to receive glucose management via a traditional paper-based protocol (PP) or a computer protocol (CP) for 72 hours, then crossed over to the alternate method for an additional 72 hours. Results Time in target glucose range (80-110 mg/dl) was higher in the CP group (47 ± 17% versus 41 ± 16.6%; p ≤ 0.05); time over target range was not significantly reduced in the CP group (49 ± 17.8% versus 54 ± 17.1; p = 0.08); and no difference was noted in time under target range of 80 mg/dl (CP 4.5 ± 2.8, PP 4.8 ± 3.3%; p = 0.8), under 60 mg/dl (p = 0.7), and under 40 mg/dl (p = 1.0). Severe hypoglycemic events (< 40 mg/dl) did not differ from the CP group compared to historical controls for patients receiving no insulin (p = 0.6). More glucose measurements were performed in the CP group (p = 0.0003), and nursing staff compliance with CP recommendations was greater (p < 0.0001). Conclusions Glycemic control using CDSS is safe and effective for the critically burned patient. Time in target range improved without increase in hypoglycemic events. CDSS enhanced consistency in practice, providing standardization among nursing staff. PMID:21240001

  16. Integration of Rule Based Expert Systems and Case Based Reasoning in an Acute Bacterial Meningitis Clinical Decision Support System

    CERN Document Server

    Cabrera, Mariana Maceiras

    2010-01-01

    This article presents the results of the research carried out on the development of a medical diagnostic system applied to the Acute Bacterial Meningitis, using the Case Based Reasoning methodology. The research was focused on the implementation of the adaptation stage, from the integration of Case Based Reasoning and Rule Based Expert Systems. In this adaptation stage we use a higher level RBC that stores and allows reutilizing change experiences, combined with a classic rule-based inference engine. In order to take into account the most evident clinical situation, a pre-diagnosis stage is implemented using a rule engine that, given an evident situation, emits the corresponding diagnosis and avoids the complete process.

  17. Bone Health Monitoring in Astronauts: Recommended Use of Quantitative Computed Tomography [QCT] for Clinical and Operational Decisions

    Science.gov (United States)

    Sibonga, J. D.; Truskowski, P.

    2010-01-01

    This slide presentation reviews the concerns that astronauts in long duration flights might have a greater risk of bone fracture as they age than the general population. A panel of experts was convened to review the information and recommend mechanisms to monitor the health of bones in astronauts. The use of Quantitative Computed Tomography (QCT) scans for risk surveillance to detect the clinical trigger and to inform countermeasure evaluation is reviewed. An added benefit of QCT is that it facilitates an individualized estimation of bone strength by Finite Element Modeling (FEM), that can inform approaches for bone rehabilitation. The use of FEM is reviewed as a process that arrives at a composite number to estimate bone strength, because it integrates multiple factors.

  18. The impact of initial statin treatment decisions on cardiovascular outcomes in clinical care settings: estimates using the Archimedes Model

    Directory of Open Access Journals (Sweden)

    van Herick A

    2012-11-01

    Full Text Available Andrew van Herick,1 C Andy Schuetz,1 Peter Alperin,1 Michael Bullano,2 Sanjeev Balu,2 Sanjay Gandhi21Archimedes, Inc, San Francisco, CA, USA; 2AstraZeneca Pharmaceuticals LP, Wilmington, DE, USAPurpose: Many patients treated for dyslipidemia do not achieve recommended cholesterol goals despite the widespread availability of effective statins. Pharmaceutical claims show a strong tendency for patients to remain on their initially assigned treatment. With computer simulations, the impact of initial statin treatment decisions on medium- and long-term cardiovascular outcomes were examined.Patients and methods: Using the Archimedes Model, three treatment scenarios were simulated. Patients initiated treatment with simvastatin (20, 40, or 80 mg, atorvastatin (10, 20, 40, or 80 mg, or rosuvastatin (10, 20, or 40 mg, and periodically intensified treatment. The simulated population consisted of 50,025 patients, aged 45–70 years, with low-density lipoprotein cholesterol exceeding goal. The proportion of patients initiating each dose was calibrated to United States pharmacy claims. Patients not reaching goal intensified the dose of their current statin or switched to an appropriate dose of rosuvastatin at rates matching pharmacy claims. Biomarkers and major adverse cardiovascular events (MACE were tracked for 10 years and several high-risk subpopulations were analyzed. Statin models used biomarker effects from the STELLAR (Statin Therapies for Elevated Lipid Levels Compared Across Doses to Rosuvastatin trial and outcomes data from various trials.Results: Initiating therapy with rosuvastatin reduced MACE more than simvastatin or atorvastatin. The 5- year relative risk of MACE was 0.906 (95% confidence interval: 0.888–0.923; P < 0.001 for initial treatment with atorvastatin rather than simvastatin, 0.831 (0.812–0.850; P < 0.001 for rosuvastatin rather than simvastatin, and 0.918 (0.898–0.938; P < 0.001 for rosuvastatin rather than atorvastatin

  19. Spurious rise in the automated platelet count because of bacteria

    OpenAIRE

    Kakkar, N

    2004-01-01

    The era of automation in haematology, although improving the accuracy and precision of results, has also introduced the laboratory haematologist to a vast array of spurious parameters. The identification of these results is important so that inappropriate management decisions are avoided. The case presented here illustrates a spuriously raised automated platelet count resulting from bacterial overgrowth in the blood sample.

  20. Impact of 11C-choline PET/CT on clinical decision making in recurrent prostate cancer: results from a retrospective two-centre trial

    International Nuclear Information System (INIS)

    The aim of this retrospective two-centre study was to investigate the clinical impact of 11C-choline PET/CT on treatment management decisions in patients with recurrent prostate cancer (rPCa) after radical therapy. Enrolled in this retrospective study were 150 patients (95 from Bologna, 55 from Wuerzburg) with rPCa and biochemical relapse (PSA mean ± SD 4.3 ± 5.5 ng/mL, range 0.2-39.4 ng/mL) after radical therapy. The intended treatment before PET/CT was salvage radiotherapy of the prostatic bed in 95 patients and palliative androgen deprivation therapy (ADT) in 55 patients. The effective clinical impact of 11C-choline PET/CT was rated as major (change in therapeutic approach), minor (same treatment, but modified therapeutic strategy) or none. Multivariate binary logistic regression analysis included PSA level, PSA kinetics, ongoing ADT, Gleason score, TNM, age and time to relapse. Changes in therapy after 11C-choline PET/CT were implemented in 70 of the 150 patients (46.7 %). A major clinical impact was observed in 27 patients (18 %) and a minor clinical impact in 43 (28.7 %). 11C-choline PET/CT was positive in 109 patients (72.7 %) detecting local relapse (prostate bed and/or iliac lymph nodes and/or pararectal lymph nodes) in 64 patients (42.7 %). Distant relapse (paraaortic and/or retroperitoneal lymph nodes and/or bone lesions) was seen in 31 patients (20.7 %), and both local and distant relapse in 14 (9.3 %). A significant difference was observed in PSA level and PSA kinetics between PET-positive and PET-negative patients (p 0.05). In both centres the same criteria to validate PET-positive findings were used: in 17.3 % of patients by histology and in 82.7 % of patients by correlative imaging and/or clinical follow-up (follow-up mean 20.5 months, median 18.3 months, range 6.2-60 months). 11C-Choline PET/CT had a significant impact on therapeutic management in rPCa patients. It led to an overall change in 46.7 % of patients, with a major clinical change